Posterior mediastinal hematoma after a simple fall in a patient with normal coagulation

Area of Science:

• Emergency Medicine
• Radiology
• Anatomy

Background:

• Neck hyperextension injuries can lead to unexpected complications.
• Posterior mediastinal hematomas are rare, especially in patients without coagulopathies.

Observation:

• A 77-year-old woman presented with neck swelling and odynophagia after a fall.
• CT imaging revealed a soft tissue mass in the carotid space, retropharyngeal space, and posterior mediastinum.
• The patient had no history of antiplatelet or anticoagulant use and normal coagulation.

Findings:

• The posterior mediastinal hematoma decreased spontaneously in size over 10 days.
• The patient experienced overall clinical improvement without airway obstruction.

Implications:

• This is the first reported case of a posterior mediastinal hematoma secondary to neck hyperextension from a simple fall in a patient with normal coagulation.
• Emergency physicians must consider the possibility of hematoma formation and potential airway compromise following seemingly minor falls involving neck hyperextension.
• Prompt recognition and observation are crucial for managing such cases effectively.