Laboratory Studies
Studies include the following:
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CBC (with special attention to the WBC count and differential, as well as the hemoglobin level)
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Hematologic laboratories to evaluate for bleeding diathesis
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Complete metabolic panel
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Type and screen for potential blood product transfusion
Imaging Studies
See the list below:
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A lateral soft tissue radiograph of the neck shows widening of the retropharyngeal area, the prevertebral area, or both.
The radiograph should be obtained during inspiration, and the patient's neck should be in the normal extended position.
The area to examine is between the vertebrae and the radiolucent airway at the anterior aspect. At the level of C2, a measurement of up to 7 mm is considered normal for all age groups. At the level of C4-6, the normal measurement is up to 15 mm in patients younger than 16 years or 22 mm in adults.
Lateral soft tissue radiograph of an elderly patient who presented with a retropharyngeal hematoma after a fall.
Chest radiograph of the same patient as in the image above. Note the soft tissue shadow in the superior mediastinum.
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Many authors consider contrast-enhanced CT scanning of the neck and chest to be the investigation of choice (see the image below).
Enhanced CT scans delineate the hematoma and help to differentiate blood from pus.
The level of obstruction and extent of the hematoma are shown.
Small vertebral body fractures may be revealed.
Data obtained with CT scan can facilitate the planning of anesthesia and surgery.
Sagittal image from a contrasted computed tomography (CT) scan of the neck in a patient with a retropharyngeal hematoma. Note that the patient is intubated and the posterior pharyngeal wall is displaced anteriorly. Courtesy of Case Reports in Emergency Medicine journal [Betten DP, Jaquint JL. Traumatic Retropharyngeal Hematoma in a Patient Taking Clopidogrel. Case Rep Emerg Med. 2018 Aug 13. Online at: https://www.hindawi.com/journals/criem/2018/6147473/].
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Gadolinium-enhanced magnetic resonance imaging (MRI) of the neck and chest can also accurately delineate the extent of the hematoma and help to differentiate blood from pus. However, this imaging modality is less often used, because patients with retropharyngeal hematoma are not appropriate candidates for long scanning times, especially since respiratory distress can evolve.
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Imaging is helpful in monitoring the progression of the hematoma, and some authors advise repeat CT scanning if the patient's condition deteriorates.
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Lateral soft tissue radiograph of an elderly patient who presented with a retropharyngeal hematoma after a fall.
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Chest radiograph of the same patient as in the image above. Note the soft tissue shadow in the superior mediastinum.
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Sagittal image from a contrasted computed tomography (CT) scan of the neck in a patient with a retropharyngeal hematoma. Note that the patient is intubated and the posterior pharyngeal wall is displaced anteriorly. Courtesy of Case Reports in Emergency Medicine journal [Betten DP, Jaquint JL. Traumatic Retropharyngeal Hematoma in a Patient Taking Clopidogrel. Case Rep Emerg Med. 2018 Aug 13. Online at: https://www.hindawi.com/journals/criem/2018/6147473/].
