LAUSR

A 78-year-old, female patient was referred to the department of otolaryngology due to subjective difficulties during swallowing and neck stiffness for two weeks. Primary clinical investigation revealed a superficial hematoma below the right mandible, not significant in size and without any history of recent trauma. During transnasal endoscopic examination of the nose, pharynx and larynx, a hematoma of the mucosa was detected. The hematoma was sharply limited to the vestibular folds and the vocal folds on both sides and did not lead to relevant swelling or narrowness (Fig. 1). There was no accumulation of saliva, neither any sign of a foreign body. Agility of both vocal folds was not reduced to any extend. Hoarseness was clinically not significant, breathing was normal in frequency and there was no stridor, not even during forced breathing. Besides a changed color of the mucosa due to the hematoma, there was no sign of injury or suspicious mass. The patient was admitted to the in-patient clinics for further observation. Initial lab testing revealed leukocytosis (12,090/μl; upper limit of normal [ULN] 9000/ μl), thrombocytosis (429,000/μl; ULN 400,000/μl) and mildly reduced hemoglobin (10.2 g/dl; lower limit of normal [LLN] 12.0 g/dl). C-reactive protein as well as neutrophils were elevated with 16.4 mg/dl (ULN 0.5 mg/dl) and 77.8% (ULN 70%), respectively. A subsequent contrast-enhanced computed tomography of the neck excluded acute arterial bleeding or a submucosal mass. Within 6 h after admission, the patient complained about a sudden and severe pain of the left leg. Clinical examination revealed considerable swelling due to a hematoma in the left lower leg as well as petechia of the right ankle without swelling (Fig. 2). Immediate angiological consultation excluded thrombosis of the deep veins by duplex sonography, however, the swelling increased constantly and visibly. The patient was transferred to the department of orthopedics and traumatology, where surgical therapy was indicated because of imminent compartment syndrome. Fiber optic intubation was performed under attendance of an otolaryngologist, without further complications and without signs of further laryngeal swelling.