A neck hematoma is a localized collection of blood that forms outside blood vessels within the neck. This occurs when blood leaks from damaged vessels, pooling within the soft tissues. These collections vary in size, and their severity often relates to their size and proximity to important neck structures.
Recognizing a Neck Hematoma
Increased swelling in the neck is a primary indicator of a neck hematoma. This swelling often accompanies bruising or skin discoloration. Individuals might also experience pain or tenderness when the neck is touched or moved.
As the hematoma expands, it can exert pressure on surrounding structures, leading to concerning symptoms. Difficulty swallowing (dysphagia) or painful swallowing may occur if the hematoma presses on the esophagus. Voice changes, such as hoarseness, can result from pressure on the larynx or vocal cords.
A rapidly expanding neck hematoma can quickly lead to respiratory distress. Symptoms like shortness of breath, increased breathing rate, noisy breathing (stridor), or agitation can signal airway obstruction. This occurs because the accumulating blood can directly compress the trachea or cause swelling in surrounding tissues, compromising the airway.
Common Causes and Risk Factors
Neck hematomas can arise from various sources, with trauma being a frequent cause. Blunt force injuries to the neck, such as those from car accidents, falls, or direct blows, can damage blood vessels and lead to blood accumulation. Penetrating injuries can also cause hematomas if bleeding continues internally after the skin seals.
Surgical procedures in the neck are another common cause. Operations like thyroidectomy (removal of the thyroid gland) and carotid endarterectomy (clearing blockages in carotid arteries) carry a risk of postoperative hematoma. The incidence of neck hematoma after thyroid surgery is approximately 0.1% to 3.15%, while after carotid endarterectomy, it can range from 1.2% to 12%.
Certain medical conditions and medications can increase the likelihood of a neck hematoma. Bleeding disorders, such as hemophilia, impair the body’s ability to clot blood, making individuals more susceptible. Patients taking anticoagulant medications (blood thinners) also have an increased risk of bleeding. In rare instances, neck hematomas can occur spontaneously due to a ruptured blood vessel, cyst, or tumor.
Medical Evaluation and Treatment
If a neck hematoma is suspected, particularly if rapidly growing or causing difficulty breathing or swallowing, immediate medical attention is necessary. Healthcare professionals typically begin with a physical examination to assess the size, location, and potential impact of the hematoma on surrounding structures. They also evaluate vital signs and the patient’s overall condition.
Diagnostic imaging techniques are employed to confirm the presence of a hematoma, determine its size and extent, and identify the source of bleeding. Ultrasound, a non-invasive imaging method, can show pooling blood and assess blood flow. Computed tomography (CT) scans provide detailed cross-sectional images of the neck, helping to visualize the hematoma and its relationship to the trachea, esophagus, and major blood vessels. Magnetic resonance imaging (MRI) can also be used to show soft tissue involvement. In some cases, angiography may be performed to pinpoint the bleeding vessel.
Treatment approaches vary depending on the hematoma’s size, its rate of expansion, its location, and the patient’s symptoms. Smaller, stable hematomas not causing significant symptoms may be managed conservatively. This typically involves observation, applying ice packs to reduce swelling, and using over-the-counter pain relievers. The body often reabsorbs the blood over several days to weeks.
For larger, rapidly expanding, or symptomatic hematomas, active intervention is usually required. Surgical drainage is often the most effective treatment, especially if compressing vital structures or threatening the airway. This procedure involves opening the surgical site or making an incision to evacuate accumulated blood and clots, relieving pressure. Embolization, a procedure to block the bleeding vessel, may be considered. Patients on anticoagulant therapy may require medication adjustments or reversal.
Understanding Potential Complications
Neck hematomas can lead to several serious complications, especially if they are large, rapidly expanding, or untreated. The most significant concern is airway obstruction, which can occur due to direct pressure on the trachea or swelling in the surrounding tissues. This can lead to life-threatening respiratory distress.
Nerve damage is another potential complication, as the expanding hematoma can compress nerves in the neck. This compression can manifest as voice changes, difficulty swallowing, or weakness in areas supplied by the affected nerves. While less common, infection of the hematoma can occur, potentially leading to an abscess.
Persistent cosmetic deformities may also result from large hematomas, even after the blood has been reabsorbed or drained. The severity of complications underscores the importance of prompt recognition and appropriate medical management of neck hematomas.