Dyspnea following spontaneous hematoma of the oropharynx and the larynx ina patient on coumarin medication

A patient with a history of tachycardiac atrial fibrillation and pulmonary embolism was admitted to the emergency unit with acute shortness of breath. The patient was on coumarin medication. Pulmonary embolism, heart failure, or pulmonary edema could be ruled out. Laryngoscopy revealed a huge hemato ma of both valleculae extending to the lateral pharyngeal wall and the epig lottis. The epiglottic cartilage was displaced to the posterior pharyngeal wall. The INR was > 6. Prothrombin complex,vitamin K1, corticoids,and fresh frozen plasma were administered immediately. The patient was monitored - w ithout tracheotomy - in the intensive care unit and received oxygen. In a p atient with dyspnea, impaired ventilation has to be considered besides impa ired perfusion or diffusion.