経食道心エコー検査後に発症した喉頭・下咽頭損傷の 1 例

Transesophageal echocardiography (TEE) is performed with an echo probe inserted into the esophagus to evaluate the cardiac status from the esophagus, including searching for intracardiac thrombi and evaluating valvular diseases that cannot be adequately assessed by transthoracic echocardiography. Complications of TEE include lip injury, dental injury, hoarseness of voice, dysphagia, pharyngeal hemorrhage, laryngospasm, upper gastrointestinal bleeding, and perforation of the esophagus. Herein, we report a case of pharyngeal hematoma that developed after TEE. The patient was an 88-year-old woman with aortic stenosis, atrial fibrillation, myocardial infarction, who was under treatment with the anticoagulant drugs clopidogrel and edoxaban. A TEE was performed 1 day prior to the patient's first visit to our department. The following morning, she developed hemoptysis and hoarseness at the same time, and was brought to the emergency room. Pharyngoscopy revealed a hematoma in the left larynx. Since the hematoma covered most of the vocal cords and there was a risk of asphyxia due to increase in the size of the hematoma, we performed emergency tracheotomy and the patient was urgently admitted to the hospital. After admission, the patient was treated conservatively with hemostatic agents. Since the hematoma shrank gradually in size, the tracheal cannula was removed on the 14th day after the symptom onset. TEE rarely causes serious complications that require the attention of an otorhinolaryngologist.