Skip to main content

Spontaneous retropharyngeal haematoma: a rare cause of upper airway obstruction


Extensive retropharyngeal haemorrhage is a rare event, which is occasionally encountered in clinical practice, but very seldom at autopsy. A 43-year-old woman who presented with difficulty breathing after a week’s history of sore throat and coughing is reported. She collapsed at a medical centre and was not able to be resuscitated. Staff noted that she had ‘swelling’ of her throat. At autopsy, the major findings were in the anterior neck where there was extensive and diffuse retropharyngeal haemorrhage extending throughout the soft tissue planes resulting in marked stenosis of the laryngeal inlet. There was no evidence of external or internal trauma, and although no specific source of the retropharyngeal haemorrhage was identified, the haemorrhage clearly originated from the retropharyngeal space with diffuse extension Her past medical history included anticoagulation for atrial fibrillation and heart valve replacements, hepatic steatosis and sleep apnoea. This case demonstrates a significant complication of oral anticoagulation therapy with underlying comorbidities which may result in significant neck haemorrhage with critical upper airway narrowing and rapid clinical deterioration.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5


  1. Wick R, Gilbert JD, Byard RW. Café coronary syndrome – fatal choking on food: an autopsy approach. J Clin Forensic Med. 2006;13:135–8.

    Article  Google Scholar 

  2. Kiho L, Byard RW. Acute fatal upper airway obstruction from an occult cavernous hemangioma of the larynx. J Forensic Sci. 2015;60(Suppl 1):S93–6.

    Article  Google Scholar 

  3. Byard RW, Heath K. Variable mechanisms of sudden and unexpected death in cases of occult carcinoma of the larynx. Am J Forensic Med Pathol. 2021;42:92–5.

    Article  Google Scholar 

  4. Warken C, Rotter N, Maurer JT, et al. Retropharyngeal hematoma in the context of obstructive sleep apnea: a case report and review of the literature. J Med Case Reports. 2019;13:269.

    Article  Google Scholar 

  5. Munoz A, Fischbein NJ, de Vergas J, et al. Spontaneous retropharyngeal hematoma: diagnosis by MR Imaging. Am J Neuroradiol. 2001;22:1209–11.

    CAS  PubMed  PubMed Central  Google Scholar 

  6. Hsu T, Tsai T, Yang C, et al. Near-fatal sore throat. Lancet. 2008;371:1136.

    Article  Google Scholar 

  7. Sing A, Ofo E, Cumberworth V. Spontaneous retropharyngeal haematoma: a case report. J Med Case Reports. 2008;2:8.

    Article  Google Scholar 

  8. Kang SS, Jung SH, Kim MY, et al. Spontaneous retropharyngeal hematoma – a case report. Korean J Pain. 2010;23(3):211–4.

    CAS  Article  Google Scholar 

  9. Peyron P, Pollanen MS. Fatal acute retropharyngeal haemorrhage in neurofibromatosis type 1. Forensic Sci Med Pathol. 2017;13:436–40.

    Article  Google Scholar 

  10. Wen S, Unuma K, Watanabe R, et al. Forensic evaluation of fatal-suffocating retropharyngeal haematoma secondary to cervical fractures: report of two cases. J Forensic Leg Med. 2022;85:102274.

  11. Quick E, Byard RW. Postoperative cervical soft tissue haemorrhage with acute upper airway obstruction. J Forensic Sci. 2013;58(Suppl 1):S264–6.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Marianne Tiemensma.

Ethics declarations

Ethical approval

Not required for coronial cases.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Tiemensma, M., Byard, R.W. Spontaneous retropharyngeal haematoma: a rare cause of upper airway obstruction. Forensic Sci Med Pathol 18, 219–222 (2022).

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Extensive retropharyngeal haemorrhage
  • Critical upper airway narrowing
  • Autopsy
  • Anticoagulation