Spontaneous retropharyngeal hemorrhage from a cervical parathyroid adenoma is a rare complication of primary hyperparathyroidism. Because of its rarity, it has seldom been documented in the radiologic or ENT literature. Patients may present with a variety of manifestations, ranging from dysphagia to dysphonia to life-threatening dyspnea or hemorrhage. Awareness of a possible thyroid or parathyroid etiology may expedite treatment and prevent unnecessary interventions. We present a case of spontaneous retropharyngeal hemorrhage in which the "sentinel clot" sign enabled us to identify the lesion of origin.