CRCM  Vol.2 No.3 , June 2013
Retropharyngeal emphysema: An unusual aetiology—A case report and literature review
Abstract: Introduction: Retropharyngeal emphysema is a potentially life threatening condition which may require urgent diagnosis and intervention. It has been documented to occur following trauma to the aerodigestive tract and is usually accompanied by subcutaneous emphysema of the cervical region. This condition may be complicated by mediastinal emphysema and pneumomediastinum. Foreign body ingestion is quite common in little children and in this environment; a cultural practice is for mothers or other caregivers to attempt to remove these foreign bodies by forcing their finger(s) down the oropharynx and Hypopharynx of these young children. This usually results in injuries to these anatomical sites. Retropharyngeal emphysema complicating this practice is rarely reported. Case presentation: We present the case of a 4-year-old Nigerian boy who presented with stridor and severe dyspnoea following repeated attempts at removal of a purportedly ingested foreign body by his mother. Examination revealed oedema of the soft palate with small multiple bleeding shallow lacerations of the oropharyngeal walls. Oxygen therapy was commenced and preparations for urgent upper airway intervention made. Soft tissue neck X-ray revealed retropharyngeal and subcutaneous emphysema with upper airway compromise. Conservative treatment with high dose steroids and antibiotics led to a gradual resolution of the condition. Conclusion: This is a rarely reported complication of this relatively common socio-cultural “foreign body removal method”. Public awareness is required to stop this potentially life threatening practice.
Cite this paper: Adekunle, D. and Adekunle, O. (2013) Retropharyngeal emphysema: An unusual aetiology—A case report and literature review. Case Reports in Clinical Medicine, 2, 194-197. doi: 10.4236/crcm.2013.23053.

[1]   Mauder, R.J., Pierson, D.J. and Hudson, L.D. (1984) Subcutaneous and mediastinal emphysema; Pathophysiology, diagnosis and management. Archives of Internal Medicine, 144, 1447-1453. doi:10.1001/archinte.1984.00350190143024

[2]   Bhatia, P.L. (1989) Hypopharyngeal and oesophageal foreign bodies. East African Medical Journal, 66, 804-811.

[3]   Brown, S. (1949) Diffuse emphysema following a double contrast enema. Radiology, 37, 228-229.

[4]   Sausin, L., LaBruna, A., Levine, J. and Komser, A. (1997) Subcutaneous and retropharyngeal emphysema after dental procedures. Otolaryngology, Head and Neck Surgery, 117, 122-123. doi:10.1016/S0194-5998(97)70219-5

[5]   Fortes, F., Sennes, L.U., Fortes, F.S.G., Immamura, R. and Tsuyi, D.H. (2007) Cervical emphysema as an early complication of tonsillectomy. International Archives of Otorhinolaryngology, 11, 65-69.

[6]   Azenha, M.R., Yamaji, M.A., Avelar, R.L., de Freitas, Q.E., Laureano Filho, J.R. and de Oliveira Neto, P.J. (2011) Retropharyngeal and cervicofacial subcutaneous emphysema after maxillofacial trauma. Oral and Maxillofacial Surgery, 15, 245-249. doi:10.1007/s10006-010-0246-5

[7]   Barlev, D.M., Nagourney, B.A. and Saintoge, R. (2003) Traumatic retropharyngeal emphysema as a cause of severe respiratory distress in a new born. Paediatric Radiology, 33, 429-432.

[8]   Riccio, J.C. and Abbott, J. (1990) A simple sore throat? Retropharyngeal emphysema secondary to free-basing cocaine. Journal of Emergency Medicine, 8, 709-712. doi:10.1016/0736-4679(90)90283-2

[9]   Onwudike, M. (1996) Ecstasy induced retropharyngeal emphysema. Journal of Accident and Emergency Medicine, 13, 359-361. doi:10.1136/emj.13.5.359

[10]   Wu, Z.B., Patel, N. and Holliday, R. (2006) Spontaneous Retropharyngeal emphysema. Otolaryngology, Head and Neck Surgery, 134, 170-172. doi:10.1016/j.otohns.2004.12.006

[11]   Mukherjee, A., Haldar, D., Dutta, S., Dutta, M., Saha, J. and Sinha, R. (2011) Ear, nose and throat foreign bodies in children: A search for socio-demographic correlates. International Journal of Paediatric Otorhinolaryngology, 75, 510-512. doi:10.1016/j.ijporl.2011.01.006

[12]   Breznick, D.A. and Saporito, J.L. (1989) Iatrogenic retropharyngeal emphysema with impending airway obstruction. Otolaryngology, Head and Neck Surgery, 115, 1367-1372. doi:10.1001/archotol.1989.01860350101024