Active upper aerodigestive tract hemorrhage in patients with head and neck cancers: the “dot-in-sludge” sign

• Authors: Abhishek Goswami, The University of Chicago; Ryan A Fisicaro, University of California, San Francisco; Brian Howard, Emory University; Milind Patel, Orlando Health, Orlando, FL USA; Ashley Aiken, Emory University; Kristen Baugnon, Emory University; Xin Wu, Emory University
• Journal Title: Emergency Radiology
• Volume: Volume 30, Number 2
• Publisher: Springer Nature | 2023-04-01, Pages 225-233
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1007/s10140-023-02118-9
• Subjects: Health Sciences, Radiology; Health Sciences, Medicine and Surgery
• Keywords: Aerodigestive tract hemorrhage; Head and neck; Oral cavity; Oropharyngeal; Squamous cell cancer; Humans; Head and Neck Neoplasms; Carcinoma, Squamous Cell; Hemorrhage; Retrospective Studies

Abstract

Active extravasation into the upper aerodigestive tract is a dramatic and potentially life-threatening complication in patients with head and neck cancers. It prompts presentation to the emergency room and subsequent urgent imaging to identify the source of hemorrhage. Imaging of these patients may be complicated by treatment-altered anatomy, posing a challenge to the emergency radiologist who needs to rapidly identify the presence of active hemorrhage and the potential source vessel. This retrospective review summarizes the clinical and imaging findings of 6 oropharyngeal and oral cavity squamous cell cancer (SCC) patients with active upper aerodigestive tract hemorrhage. Most patients had advanced stage disease and prior radiation therapy. All CECT or CTA exams on presentation demonstrated the “dot-in-sludge” sign of active extravasation, as demonstrated by a “dot” of avidly enhancing extravasated contrast material layered against a background “sludge” of non-enhancing debris in the lumen of the upper aerodigestive tract. Common sources of hemorrhage included the lingual, facial, and superior thyroidal arteries. Familiarity with these findings will help radiologists increase their accuracy and confidence in interpreting these urgent, complex examinations.