Traumatic retropharyngeal hematoma successfully treated with n-butyl cyanoacrylate transarterial embolization: A case report and literature review

Traumatic retropharyngeal hematoma (RPH) is a rare but potentially life-threatening condition; in fact, rapid hematoma expansion may lead to acute airway compromise. Although conservative management is often selected, prompt identification of active bleeding and appropriate intervention are crucial. Transarterial embolization (TAE) has recently emerged as a viable therapeutic option, particularly in cases with contrast extravasation on contrast-enhanced computed tomography (CT). We report a case of a 70-year-old man who developed traumatic RPH after a blunt head and neck injury from a fall. Contrast-enhanced CT revealed a retropharyngeal hematoma with active contrast extravasation along the anterior aspect of the lower cervical vertebrae. Angiography identified the bleeding source as the ascending cervical artery arising from the thyrocervical trunk. TAE was successfully performed using a combination of 25% n-butyl cyanoacrylate (NBCA) and coils. Hemostasis was achieved without ischemic complications. Although delayed airway compromise required temporary mechanical ventilation, follow-up imaging confirmed resolution of active bleeding and gradual hematoma reduction, and the patient recovered without rebleeding. TAE using NBCA can be an effective and rapid hemostatic strategy for traumatic RPH with active extravasation. Careful embolic material selection and meticulous attention to the complex vascular anatomy of the head and neck are essential to avoid complications. Furthermore, careful evaluation of the retropharyngeal space and contrast-enhanced CT are critical for timely diagnosis and treatment decision-making. This report underscores the potential role of NBCA-based embolization as a life-saving option in selected traumatic RPH cases.