Spontaneous cervical hemorrhage is a rare emergency with the common clinical manifestations of acute throat discomfort, neck swelling, difficulty in swallowing, or hoarseness. Endotracheal intubation may be indicated if airway obstruction occurs to prevent life-threatening complication. Identifiable etiologies such as use of anticoagulant or antiplatelet, bleeding diathesis related to underlying diseases, thyroid or parathyroid tumor, vascular malformation or rupture, prior operation, or head and neck trauma have been reported. Subsequent surgical exploration and repair of the ruptured vessel in addition to correction of identifiable etiologies facilitate the recovery. We report a case of spontaneous cervical hemorrhage in an 89-year-old woman with odynophagia and lumping sensation over throat after vigorous coughing for one day. Flexible nasopharyngoscopy revealed hematoma over left oropharynx with extension downwardly to pharynx. Endotracheal intubation was performed due to subsequent progression of the hematoma to the contralateral side. Images of the computed tomography confirmed involvement of the parapharyngeal and retropharyngeal space without extravasation of the contrast media. Angiography with trans-arterial embolization or surgical exploration was not feasible owing to her impaired renal function and advanced age. The response to conservative medical treatment was good with the hematoma subsided dramatically and she was discharged without complication after total recovery. Early identification of spontaneous cervical hemorrhage and regular monitoring of the airway with flexible nasopharyngoscopy are crucial to prevent life threatening airway obstruction. Exploration of possible etiologies benefits further management decision making. Either conservative treatment, endovascular intervention, or surgical exploration can successfully solve the condition and save life. (J Taiwan Otolaryngol Head Neck Surg 2023; 58:40-46)
