[Spontaneous haematoma on the neck]

Acute haematoma on the neck can cause potentially life-threatening compression of the upper airways. Such patients must therefore be examined quickly and carefully observed with regard to compromised airways.

An elderly male patient with obesity, known obstructive sleep apnoea and heart failure, non-severe chronic renal failure, and anticoagulation treatment presented with an acute subcutaneous haematoma of the neck. The patient had recently started an NSAID therapy regime for acute back pain. As part of the ENT examination endoscopy was performed. The airways were open and the patient had no respiratory distress. A CT scan confirmed open airways but revealed an additional circumferential haematoma in the pharynx of the patient. Blood work showed no anaemia or obvious infectious process.

The unfortunate combination of the patient's regular medications and recent acute analgesic therapy with simultaneous renal failure was likely to have contributed to the development of an acute haematoma. Acute pharyngeal haematoma has been described in the literature in patients receiving anticoagulation therapy and one or more of the above-mentioned conditions that this patient had. The haematoma was controlled and resolved without further intervention.