A Systematic Review of Case Reports of Spontaneous Retropharyngeal Hematoma.

Objective: Spontaneous retropharyngeal hematoma (SRH) is a rare and potentially life-threatening condition with the potential to cause acute airway obstruction. This review aims to describe the presentation, predisposing factors, and management of SRH cases to better understand the clinical course and guide strategies for identifying and managing this condition.

Data Sources: PubMed, Embase, and Web of Science.

Review Methods: Databases were queried for articles from inception to February 2025. Study protocols adhered to the PRISMA guidelines. Case reports and series describing SRH were included. Study validity was assessed using the Joanna Briggs institute's critical appraisal tools and AMSTAR 2 criteria.

Results: Seventeen cases (eight males and nine females) met inclusion criteria for analysis. On average, they presented at 59.7 (± 21.4) years old with sudden dysphagia (76.5%), anterior neck swelling (64.7%), neck pain (58.8%), and dysphonia (41.2%). Notably, 4 (23.5%) patients were taking an antithrombotic medication. Diagnosis was made using CT neck in 82.4% of cases. While 12 (70.6%) cases were managed medically, 5 (29.4%) received surgical intervention, and 6 (35.3%) required intubation. 16 (94.1%) cases had complete resolution within an average of 27.9 (± 24.8) days, and one patient (5.9%) died from airway compromise.

Conclusions: SRH is a rare condition that presents with nonspecific dysphagia or neck discomfort. Antithrombotic medications may serve as a risk factor. Most patients will not require operative management, but close observation is needed as progression to fatal airway compromise has been documented.