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• W4387267199 abstract "SESSION TITLE: Critical Care Case Report Posters 11 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 12:00 pm - 12:45 pm INTRODUCTION: Laryngeal hematomas can result from trauma, vocal abuse, infection, or other causes. Spontaneous hematomas can be a complication of anticoagulation, typically warfarin. Symptoms include dysphagia, dysphonia, odynophagia, neck edema and ecchymosis. Airway compromise can also occur. We report a case of a spontaneous laryngeal hematoma in an elderly female taking high-dose aspirin. CASE PRESENTATION: An 80-year-old female with osteoarthritis presented to the hospital with neck bruising and pain. Three days prior, she felt a popping sensation in her neck immediately followed by pain. The next day, she woke up with a large neck bruise. Over the following days, she developed dysphagia, odynophagia, and dysphonia prompting her to seek evaluation. On physical exam, she had stable vital signs with a large tender ecchymosis on the anterior neck from below the chin extending onto the anterior chest (image 1). Pertinent lab values include hemoglobin 11.1 g/dL, PT 14.7 sec, and INR 1.2. Computed tomography with angiography of the neck found a soft tissue mass or fluid collection in the right neck adjacent to the esophagus. Otolaryngology (ENT) performed a flexible fiberoptic laryngoscopy revealing a hematoma on the aryepiglottic fold extending on to the epiglottis. She was admitted to the intensive care unit (ICU) for monitoring. She admitted to taking high-dose aspirin for arthritic pain on the days leading up to presentation. She denied additional anticoagulant use. Her symptoms gradually improved. Repeat laryngoscopy showed improvement in the hematoma size. She was discharged with plan for ENT follow-up to rule out malignancy at a later date if the mass persisted. DISCUSSION: Laryngeal hematomas (LH) are a life-threatening condition due to risk of airway compromise. Trauma, vocal abuse, and infection are only a few etiologies of LH. Anticoagulant use is also associated with LH formation. Most cases of LH due to anticoagulantion are a result of warfarin-induced coagulopathy.1 Though less common, spontaneous upper airway hematomas can also occur in patients taking direct acting oral anticoagulants (DOACs) and antiplatelet agents such as aspirin or clopidogrel.2,3 Signs and symptoms of LH include dysphonia, odynophagia, dysphagia, dyspnea, drooling, ecchymosis, and respiratory distress. Flexible fiberoptic laryngoscopy can aid diagnosis.1 Prompt diagnosis is key to prevent airway compromise and death. Patients should be monitored closely in the ICU. Most cases are managed conservatively however some require intubation, cricothyrotomy, or tracheostomy.1 In cases associated with anticoagulation, timely correction of the underlying coagulopathy is prudent. CONCLUSIONS: LH can be a life-threatening complication of anticoagulant or antiplatelet therapy. Prompt diagnosis can improve outcomes and prevent death. Patients with LH should be monitored in the ICU for airway compromise. REFERENCE #1: Karmacharya P, Pathak R, Ghimire S, et al. Upper airway hematoma secondary to warfarin therapy: A systematic review of reported cases. North American Journal of Medical Sciences. 2015;7(11):494. doi:10.4103/1947-2714.170606 REFERENCE #2: Pelman A, Deere J, Schneider K, Van Heukelom J. Spontaneous epiglottic hematoma secondary to direct oral anticoagulant. The American Journal of Emergency Medicine. 2022;59. doi:10.1016/j.ajem.2022.06.023 REFERENCE #3: Betten DP, Jaquint JL. Traumatic retropharyngeal hematoma in a patient taking clopidogrel. Case Reports in Emergency Medicine. 2018;2018:1-3. doi:10.1155/2018/6147473 DISCLOSURES: No relevant relationships by David Carter No relevant relationships by Madison Tackett" @default.
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• W4387267199 date "2023-10-01" @default.
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• W4387267199 title "SPONTANEOUS LARYNGEAL HEMATOMA FOLLOWING HIGH DOSE ASPIRIN USE" @default.
• W4387267199 doi "https://doi.org/10.1016/j.chest.2023.07.1698" @default.
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