Figures 1 and 2. The patient's tongue on physical examination.Chief Complaint. Painful, swollen tongue. History of Present Illness.A 27-year-old man presents with a four-day history of progressive leftsided tongue swelling and pain. He additionally has difficulty handling oral secretions, and odynophagia. He denies trauma, fevers, chills, sore throat, dysphagia, or vomiting. He denies prior oral infections or recent illnesses. Past medical history is unremarkable. He has no pror surgeries or medical conditions.He is not currently taking medications and has no known allergies. Social history is significant for social alcohol use and smoking. He denies intravenous drug abuse. No HIV risk factors are identified.Physical Examination. The patient positions himself in a tripod position while wiping off saliva that drools continuously from his mouth. He appears awake and alert but is fatigued and dehydrated. His voice is muffled and he appears to have difficulty breathing. Vital signs show a blood pressure of 141/79 mm Hg, pulse rate of 82 beats/min, respiratory rate of 32 breaths/min, and temperature of 99.1ЊF (oral). Head and neck examination is significant for a fluctuant and exquisitely tender mass on the left side of the tongue (Figs. 1 and 2). The tongue is not erythematous and no external lesions are present. There is no tongue elevation or brawny edema of the submandibular region. Dentition is poor but no dental infections are evident. The oropharynx is otherwise clear with normal-appearing tonsils. Cervical lymph nodes are Laboratory. The white blood cell count is 14,000/L. No differential is obtained. The remainder of the complete blood cell count is normal. The serum potassium is 2.9 mmol/L. The remainder of the basic metabolic panel is normal.Radiologic and additional tests are performed.(The diagnosis, clinical course, discussion, and clinical pearls appear on page 941.)
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