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A Rare Case of Infected Retropharyngeal Haematoma in a 2-Year-Old Child with Coagulopathy

Hui Yan Ong, Jia Ji N, Zainal Abidin Puteri Nur Baiduri, Kalimuthu Santhi and Wei Siang Johnson Ng

Spontaneous retropharyngeal haematoma is a rare, life-threatening condition which is difficult to diagnose, especially in pediatric age group. We encountered a case of infected spontaneous retropharyngeal haematoma who presented with acute respiratory compromise. We present a case of a 2-year-old child with alagille syndrome who presented with fever, poor oral intake and left neck swelling for 3 days, worsening with acute respiratory compromise for 1 day. There was obvious widening of the prevertebral soft tissue on the lateral neck x radiograph. Tracheostomy under local anesthesia was done, and direct laryngoscopy revealed huge collection over the posterior pharyngeal wall covering almost the entire larynx. Upon incision and drainage, there was very minimal pus with blood clots. Child was subsequently treated with intravenous antibiotics and managed to wean off tracheostomy tube. Lateral neck x ray could be a valuable tool in diagnosing retropharyngeal haematoma/abscess. In a child with coagulopathy, who presented with acute shortness of breath with dysphagia, spontaneous retropharyngeal haematoma should be considered.