Extensive cervical prevertebral haemorrhage with airway obstruction after low-energy hyperextension injury

A 45-year-old man developed a massive prevertebral cervical haematoma after a low-energy hyperextension trauma with an anterior teardrop fracture of the C4 vertebra. He required urgent nasotracheal intubation because of acute respiratory obstruction. During surgical removal of the haematoma, a small segmental artery arising from the vertebral body of C4 was identified as the source of the bleeding. The anterior longitudinal ligament was intact. The patient recovered uneventfully and was discharged six days after surgery without neurological sequelae. Large prevertebral retropharyngeal hematomas in non-geriatric patients after low-energy cervical hyperextension injury are very rare, especially when the discoligamentary structures are intact. This is, to our knowledge, the first report of a small segmental artery being identified as the source of acute bleeding in such circumstances. The treatment team must be alert to the possibility of a prevertebral haematoma when dyspnoea and dysphonia arise a short time after a cervical hyperextension injury, even in cases of low-energy trauma.