Learning objectives

• Recognize an expanding neck hematoma
• Management of an expanding neck hematoma

Definition and mechanism

• Hematoma is caused by blunt neck trauma leading to the dissection of a major blood vessel or bleeding from a soft tissue injury
• May result from recent surgery or spontaneous as with a ruptured thyroidal cyst, thyroidal vessel, or parathyroid adenoma
• Affects the pharynx, larynx, esophagus, and trachea and results in airway compromise
• Theoretical potential for hemodynamic instability due to compression of the carotid sinus with resulting bradycardia/hypotension

Causes

• Injuries to the internal and/or external carotid arteries, external carotid artery deep branches, or internal jugular veins 
• Injuries to the cervical fascial layers (barriers of deep spaces) that facilitate the pooling of blood and hematoma 

Management

Keep in mind

• Intubation may be difficult and should be performed by an experienced anesthesiologist
• In case of inability to intubate, a surgical airway should be performed early

Suggested reading

• Alfraidy, D, Helmi, H, Alamodi Alghamdi, M, Bokhari, A, Alsaif, A. Rare cause of acute neck hematoma. Clin Case Rep. 2019; 7: 1378– 1381.
• Shuker ST. Expanding Hematoma’s Life-Threatening Neck and Face Emergency Management of Ballistic Injuries. J Craniofac Surg. 2 016;27(5):1282-1285.
• Shakespeare WA, Lanier WL, Perkins WJ, Pasternak JJ. Airway management in patients who develop neck hematomas after carotid endarterectomy. Anesth Analg. 2010;110(2):588-593.
• Barash PG, Cahalan MK, Cullen BF, Stock C, Stoelting RK, Ortega R, Sharar SR, Holt H. Clinical anesthesia. 2017. Eight edition. Wolters Kluwer.

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