Miguel Andrade de Almeida (Porto / PT), Joao Pedro Araújo Teixeira (Porto / PT), Tiago Pimenta (Porto / PT), Pedro Sá Couto (Porto / PT), Elisabete Barbosa (Porto / PT)
Abstract text (incl. references and figure legends)
Case history
A 54-year-old woman was admitted to the ED presenting with neck swelling which had enlarged over the course of a day, cervical stiffness, and heavy pain. The patient had no stridor but complained of dysphagia. She was a smoker and denied symptoms of upper respiratory tract infection, trauma, or the use of any medications, including anticoagulants.
Clinical findings
A large, firm, and non-fluctuant left-sided neck swelling was observed. All peripheral pulses were palpable, and she remained hemodynamically stable. Bedside ultrasound showed an extensive heterogenous mass compatible with a hematoma.
Investigation/Results
After orotracheal intubation the patient was transferred to our tertiary care center. Angio-CT confirmed a 6.7x7.4x10.0 cm hematoma dislocating the trachea and the left lobe of the thyroid to the right. Doubts remained as to the source of the bleeding.
Diagnosis
Angiography with superselective catheterization of the left inferior thyroid artery revealed active extravasation of contrast in its middle third.
Therapy and Progressions
Embolization with 8 microcoils deployed along the course of the artery stopped the bleed. Due to significant mass effect and the risk of unsafe extubation she underwent surgery. Intraoperatively considerable hemorrhagic infiltration was noted within the strap muscles, the hematoma was evacuated, the artery was ligated, and an active drain was inserted. Recovery was uneventful after extubation on the next day. The patient was discharged 3 days after the operation free of symptoms.
Comments
A spontaneous hematoma is a rare differential diagnosis of cervical mass posing a potentially life-threatening condition. Smoking is a risk factor for atherosclerosis which may have led to arterial fragility. The importance of securing the airway as soon as possible cannot be underestimated. The optimal management sequence for cases of cervical hematoma should be intubation, diagnosis, and angiography before surgery.
Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.)
No