Hemorrhagic transformation of a plunging ranula: An unusual cause of a rapidly enlarging neck mass

Rapidly expanding masses of the neck leading to serious symptoms, including potential airway compromise, are uncommon in the emergency department. We report a case of a young woman with a previously stable largely intraoral ranula, which progressed in less than 2 hours to severe symptoms including pain, stridor, and inability to handle secretions. Needle aspiration of the ranula from the sublingual approach led to immediate resolution of all symptomsand the extraction of 60 mL of thick, bloody material. The clinical diagnosis of plunging ranula was subsequently confirmed on a computed tomographic report obtained from a study performed previously at another institution. We conclude that the rapid increase in size and symptoms was the result of hemorrhage intothe preexisting structure. The patient was stable over a period of observation and discharged a day later with plans for definitive surgical management.