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A spontaneous retropharyngeal haematoma: a suspected side-effect of indomethacin

Published online by Cambridge University Press:  31 August 2021

E Crossley ,
S Goldie ,
J Kirkby-Bott  and
W Hellier
E Crossley*
Affiliation:
Department of ENT, Southampton, England, UK
S Goldie
Affiliation:
Department of ENT, Southampton, England, UK
J Kirkby-Bott
Affiliation:
Department of General Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, England, UK
W Hellier
Affiliation:
Department of ENT, Southampton, England, UK
*
Author for correspondence: Miss Eleanor Crossley, Department of ENT, University Hospital Southampton NHS Foundation Trust, Tremona Road, SouthamptonSO16 6YD, UK E-mail: eleanor.crossley@doctors.org.uk
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Abstract

Background

Retropharyngeal haematomas are most commonly associated with trauma and anti-coagulant use. This paper describes the first reported case of a spontaneous retropharyngeal haematoma suspected to be due to indomethacin use.

Case report

It is proposed that the combination of indomethacin affecting platelet aggregation, alongside the patient coughing, may have led to this retropharyngeal haematoma.

Conclusion

The complexities of management are discussed and the current literature reviewed. In the absence of airway compromise or a rapidly enlarging haematoma, patients can be managed conservatively with observation and close discussion with the haematology department. Follow-up imaging is not necessary if the patient's symptoms settle; however, any increase in parathyroid hormone levels must be investigated to exclude a parathyroid adenoma.

Keywords

HematomaIndomethacinAnti-Inflammatory AgentsNon-SteroidalNeck Pain
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 135 , Issue 11 , November 2021 , pp. 1031 - 1034
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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Footnotes

Miss E Crossley takes responsibility for the integrity of the content of the paper

References

Thomás, MD, Torres, A, García-Polo, J, Gavilán, C. Life-threatening cervico-mediastinal haematoma after carotid sinus massage. J Laryngol Otol 1991;105:381–310.1017/S0022215100116068CrossRefGoogle ScholarPubMed
Tenofsky, PL, Porter, SW, Shaw, JW. Fatal airway compromise due to retropharyngeal hematoma after airbag deployment. Am Surg 2000;66:692–4Google ScholarPubMed
Duvillard, C, Ballester, M, Romanet, P. Traumatic retropharyngeal hematoma: a rare and critical pathology needed for early diagnosis. Eur Arch Otorhinolaryngol 2005;262:713–15CrossRefGoogle ScholarPubMed
Senthuran, S, Lim, S, Gunning, KE. Life-threatening airway obstruction caused by a retropharyngeal haematoma. Anaesthesia 1999;54:674–8CrossRefGoogle ScholarPubMed
Lin, MJ, Sinclair, C. Retropharyngeal haematoma – an unusual cause of airway obstruction. J Surg Case Rep 2011;10:510.1093/jscr/2011.10.5CrossRefGoogle Scholar
Yamamoto, T, Schmidt-Niemann, M, Schindler, E. A case of acute upper airway obstruction in a pediatric hemophilia patient because of spontaneous retropharyngeal hemorrhage. Ann Emerg Med 2016;67:616–19CrossRefGoogle Scholar
Pfeiffer, J, Ridder, GJ. An elderly woman with increasing dyspnoea after a fall. BMJ Case Rep 2011;2011:bcr122010364210.1136/bcr.12.2010.3642CrossRefGoogle ScholarPubMed
Nalamachu, S, Wortmann, R. Role of indomethacin in acute pain and inflammation management: a review of the literature. Postgrad Med 2014;126:92–710.3810/pgm.2014.07.2787CrossRefGoogle ScholarPubMed
Warner, TD, Giuliano, F, Vojnovic, I, Bukasa, A, Mitchell, JA, Vane, JR. Nonsteroid drug sensitivities for cyclo-oxygenase-1 rather than cyclo-oxygenase-2 are associated with human gastrointestinal toxicity: a full in vitro analysis. Proc Natl Acad Sci U S A 1999;96:7563–810.1073/pnas.96.13.7563CrossRefGoogle Scholar
Betten, DP, Jaquint, JL. Traumatic retropharyngeal hematoma in a patient taking clopidogrel. Case Rep Emerg Med 2018;2018:6147473Google Scholar
Capps, RB. Multiple parathyroid tumors with massive mediastinal and subcutaneous haemorrhage. Am J Med Sci 1934;188:800–5CrossRefGoogle Scholar
Hellier, WPL, McCombe, A. Extracapsular haemorrhage from a parathyroid adenoma presenting as a massive cervical haematoma. J Laryngol Otol 1997;111:585–7CrossRefGoogle ScholarPubMed
Penning, L. Prevertebral hematoma in cervical spine injury: incidence and etiologic significance. AJR Am J Roentgenol 1981;136:553–61CrossRefGoogle ScholarPubMed
Van Valde, R, Sars, PRA, Olsman, JG, Van de Hoeven, H. Traumatic retropharyngeal haematoma treated by embolization of the thyrocervical trunk. Eur J Emerg Med 2002;9:159–6110.1097/00063110-200206000-00011CrossRefGoogle Scholar
Calofero, CG, Miller, AC, Greenberg, MR. Life-threatening retropharyngeal hemorrhage secondary to rupture of the inferior thyroid artery. Case Rep Emerg Med 2015:2015:789076Google Scholar
Bloom, SC, Haegen, T, Keefe, MA. Anticoagulation and spontaneous retropharyngeal haematoma. J Emerg Med 2003;24:389–94CrossRefGoogle Scholar
Lazott, LW, Ponzo, JA, Puana, RB, Artz, KS, Ciceri, DP, Culp, WC Jr. Severe upper airway obstruction due to delayed retropharyngeal haematoma formation following blunt cervical trauma. BMC Anaesthesiol 2007;7:210.1186/1471-2253-7-2CrossRefGoogle ScholarPubMed
Mitchell, RO, Heniford, BT. Traumatic retropharyngeal haematoma – a cause of acute airway obstruction. J Emerg Med 1995;13:165–710.1016/0736-4679(94)00137-5CrossRefGoogle ScholarPubMed
Simckes, AM, Chen, SS, Osorio, AV, Garola, RE, Woods, GM. Ketorolac-induced irreversible renal failure in sickle cell disease: a case report. Pediatr Nephrol 1999;13:63–710.1007/s004670050565CrossRefGoogle ScholarPubMed
Buckley, RC, Davidson, SF, Das, SK. Effects of ketorolac tromethamine (Toradol) on a functional model of microvascular thrombosis. Br J Plast Surg 1993;46:296–910.1016/0007-1226(93)90006-WCrossRefGoogle ScholarPubMed
Armstrong, K, Kirkby-Bott, J, Johnson, DW. Chest pain, syncope, and puddings. Lancet 2000;356:1322CrossRefGoogle ScholarPubMed