Logo American Journal of Case Reports

Call: 1.631.629.4328
Mon-Fri 10 am - 2 pm EST

Contact Us

Logo American Journal of Case Reports Logo American Journal of Case Reports Logo American Journal of Case Reports

23 September 2022 : Case report  Antigua and Barbuda

[In Press] Spontaneous Oropharyngeal Hemorrhage Complicated by Cirrhosis, Resulting in Hemorrhagic Shock

Unusual clinical course, Challenging differential diagnosis

Dung V. Nguyen1EF, Dena H. Tran2E, Kathryn G. Champ2E, Swetha Vutukuri2E, Avelino Verceles3E

DOI: 10.12659/AJCR.937582

Am J Case Rep In Press; DOI: 10.12659/AJCR.937582  

Available online: 2022-09-23, In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule

Abstract

BACKGROUND
Spontaneous oropharyngeal hemorrhage is rare and is often associated with other predisposing factors. This can result in hemodynamic instability in the presence of other bleeding sources. It is oftentimes difficult to diagnose due to its limitations to visual inspection of the oropharyngeal structures. It is commonly mistaken for hemoptysis or hematemesis upon initial evaluation. Trauma, infection, pulmonary pathologies (ie, lung cancer or tuberculosis), gastrointestinal pathologies (ie, esophageal/gastric varices, Mallory-Weiss tears, esophagitis), coagulopathies, medications, and prolonged intubation have been shown to increase the risk of oropharyngeal hemorrhage.
CASE REPORT
A 54-year-old man with a medical history of alcohol use disorder, liver cirrhosis, portal hypertension, and gastric varices presented with altered mental status. He was subsequently intubated for airway protection. Bleeding from the oropharynx was later found. Esophagogastroduodenoscopy (EGD) and bronchoscopy were unrevealing. Computed tomography angiography (CTA) of the head and neck revealed active bleeding of the right posterior pharyngeal artery, which was emergently embolized. Over the next few days, he continued to bleed from the oropharynx and became hemodynamically unstable. CTA abdomen showed bleeding from gastric varices and large-volume hemoperitoneum with multiple sources of active bleeding from the liver, duodenum, and jejunum.
CONCLUSIONS
We present a rare case of spontaneous oropharyngeal hemorrhage and gastric variceal bleeding resulting in hemorrhagic shock in a cirrhotic patient with multiple predisposing factors. If a patient presents with spontaneous oropharyngeal hemorrhage, clinicians should consider bleeding from the oropharynx if EGD and bronchoscopy are unrevealing. Thus, an emergent CTA of the head and neck should be strongly considered to further evaluate a potential source of active bleeding, as delayed diagnosis can be life-threatening.

Keywords: Liver Cirrhosis; Liver Cirrhosis, Alcoholic; Hepatic Encephalopathy; Esophageal and Gastric Varices; Hemorrhagic Shock and Encephalopathy Syndrome

SARS-CoV-2/COVID-19

22 September 2022 : Case report  USA

Rare Case of Persistently Depressed T Lymphocyte Subsets After SARS-CoV-2 Infection

Am J Case Rep In Press; DOI: 10.12659/AJCR.937760  

22 September 2022 : Case report  Poland

Central Retinal Vein Occlusion After Discontinuation of Rivaroxaban Therapy in a Young Patient with COVID-1...

Am J Case Rep In Press; DOI: 10.12659/AJCR.937739  

19 September 2022 : Case report  Spain

Inhaled Nitric Oxide in Acute Severe Pulmonary Hypertension and Severe Acute Respiratory Distress Syndrome ...

Am J Case Rep In Press; DOI: 10.12659/AJCR.937147  

14 September 2022 : Case report  Japan

Case Report: A 29-Year-Old Pregnant Woman at 24 Weeks of Gestation Presenting with Laryngotracheitis and CO...

Am J Case Rep In Press; DOI: 10.12659/AJCR.937834  

In Press

27 Sep 2022 : Case report  Slovenia

Compound Heterozygote Mutation in the SMPD1 Gene Leading to Nieman-Pick Disease Type A

Am J Case Rep In Press; DOI: 10.12659/AJCR.937220  

26 Sep 2022 : Case report  Saudi Arabia

An Infant Presenting with Interstitial Lung Disease Diagnosed Later as Hunter Syndrome: A Case Report

Am J Case Rep In Press; DOI: 10.12659/AJCR.937527  

26 Sep 2022 : Case report  Thailand

Acute Intermittent Porphyria: Complete Phenotype in a Patient with p.Arg173Trp Variant in Thailand

Am J Case Rep In Press; DOI: 10.12659/AJCR.937695  

26 Sep 2022 : Case report  USA

Injury to the Posterior Horn of the Lateral Meniscus from a Misplaced Tibial Tunnel for Anterior Cruciate L...

Am J Case Rep In Press; DOI: 10.12659/AJCR.937581  

Most Viewed Current Articles

13 Jul 2022 : Case report  USA

Whistling Scrotum: An Unusual Presentation of Pneumomediastinum in the Setting of an Open Scrotal Wound

DOI :10.12659/AJCR.936441

Am J Case Rep 2022; 23:e936441

23 Feb 2022 : Case report  USA

Penile Necrosis Associated with Local Intravenous Injection of Cocaine

DOI :10.12659/AJCR.935250

Am J Case Rep 2022; 23:e935250

06 Dec 2021 : Case report  Brazil

Lipedema Can Be Treated Non-Surgically: A Report of 5 Cases

DOI :10.12659/AJCR.934406

Am J Case Rep 2021; 22:e934406

17 Feb 2022 : Case report  Oman

Myocarditis, Pulmonary Hemorrhage, and Extensive Myositis with Rhabdomyolysis 12 Days After First Dose of P...

DOI :10.12659/AJCR.934399

Am J Case Rep 2022; 23:e934399

Your Privacy

We use cookies to ensure the functionality of our website, to personalize content and advertising, to provide social media features, and to analyze our traffic. If you allow us to do so, we also inform our social media, advertising and analysis partners about your use of our website, You can decise for yourself which categories you you want to deny or allow. Please note that based on your settings not all functionalities of the site are available. View our privacy policy.

American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923