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Spontaneous retropharyngeal haematoma with direct oral anticoagulant medication
  1. Munir Abukhder1,
  2. Jonathan Hulme2,
  3. Shakira Nathoo2 and
  4. Shubhi Shubhi3
  1. 1General Surgery, Prince Charles Hospital, Merthyr Tydfil, UK
  2. 2Intensive Care Medicine & Anaesthesia, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
  3. 3Ear, nose and throat, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
  1. Correspondence to Dr Munir Abukhder; munir.abukhder1{at}


A 79-year-old man presented to the emergency department following a 1-week history of dyspnoea, dysphonia, dysphagia and a nonproductive cough. Previous medical history included atrial fibrillation, for which he was taking rivaroxaban, hypertension and obstructive sleep apnoea. On assessment, there was a mild stridor, swelling of the anterior aspect of the neck and submandibular bruising. CT of the neck demonstrated prevertebral soft tissue swelling extending from C1 to C6 levels, approximately 88 mm in length with a maximum depth of 25 mm. A diagnosis of spontaneous retropharyngeal haematoma was made: the airway was secured with fibreoptic nasal intubation and the patient admitted to the intensive care unit. Direct and fibreoptic assessment of the airway on day 3 confirmed that the haematoma had significantly reduced in size. The patient was extubated on day 4 and made a good recovery.

  • ear
  • nose and throat/otolaryngology
  • otolaryngology / ENT
  • surgery
  • intensive care

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  • Contributors JH: guarantor, identified and managed the case, provided guidance in literature search, revision of case report, final approval of case report. SN: identified and managed the case, revision of case report. SS: managed the case, revision of case report. MA: assisted in the management of the case, literature search, writing up the case report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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