Images in Clinical Medicine. Spontaneous Retropharyngeal Hematoma

A 56-year-old man presented to the emergency department with a 5-hour history of throat swelling and pain and difficulty breathing that was exacerbated by supine positioning; he had not had any obvious antecedent trauma. His medical history included prostate cancer, hypertension, hyperlipidemia, deep-vein thrombosis, and stroke. Medications included warfarin (presumably for deep-vein thrombosis), antihypertensive agents, and a statin. He was afebrile, and the physical examination was notable for minor swelling of the posterior oropharynx. Laboratory studies revealed a normal white-cell count, an international normalized ratio of more than 11, a prothrombin time of more than 120 seconds, and an activated . . .