Tongue Necrosis in a Patient with Essential Thrombocytosis

Fernández-Casado, Alejandro; Sánchez‐González, Blanca

doi:10.1056/nejmicm0807709

Cited by 7 publications

(3 citation statements)

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“…The decreased vascularity might have contributed to the well-defined discoloration in the cranial half of the tongue. The discoloration resembled findings of local lingual thrombosis and infarction following the progression of necrotic changes in previous human cases [16]. In addition, damage to both deep lingual arteries running parallel to the tongue is a possible cause of lingual necrosis in humans [15].…”

Section: Discussionsupporting

confidence: 63%

Ultrasonography of sudden swollen tongue in a calf

et al. 2020

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Background: In cattle, the lingual diseases are primarily diagnosed postmortem by histopathological examination of the affected tongues obtained after the death or during necropsy. In humans, ultrasonography has been used to provide differential diagnoses, and for preoperative or intraoperative planning of glossectomy in various lingual diseases. This is a bovine clinical case report, in which ultrasonography for sudden swelling of the tongue, which was possibly caused by snake bite, was utilized as a preoperative indication to perform a glossectomy. Case presentation: An eight-month-old female Japanese black calf presented with sudden swelling of the tongue with well-defined discoloration in the cranial region. A 10-MHz linear probe on a portable-type ultrasound machine (MyLabOne VET, Esaote Co., Genova, Italy) was applied to the ventral surface of the tongues in the affected case, and also in five healthy calves under sedation to observe normal tongues. Ultrasonography of the swollen tongue in this case revealed that the ventral lingual muscular layers were severely thickened compared with those of normal tongues. However, the muscle layers were regularly aligned with the echogenic muscular fibers. This resembled the lingual muscular architectures of normal tongues. Color-flow Doppler ultrasonography revealed that blood flow was weakened in the small peripheral vessels in the spaces between the lingual muscular structures, and was lacking in the deep lingual artery between the apex and base of the tongue. This finding was very different than that of normal tongues, which exhibited weakened or rich blood flows. Based on ultrasonographic findings, this case was treated with glossectomy. After recovery, the calf grew up normally with a normal appetite and rumination, and did not exhibit mouth pain behavior. Histopathologically, hemorrhagic necrotic changes, together with focal formation of fibrin thrombus in the lingual blood vessels in the affected tongue, were noted. Conclusions: To the best of our knowledge, the present report is the first description of lingual ultrasonography performed in cattle. In this case, ultrasonography enabled visualization of decreased vascularity, which might be associated with hemorrhage or formation of fibrin thrombus in the suddenly swollen tongue presented.

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Section: Discussionsupporting

confidence: 63%

Ultrasonography of sudden swollen tongue in a calf

et al. 2020

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“…One case has been reported of tongue necrosis in a patient with disseminated intravascular coagulation, during the early consumptive coagulation phase 16. Another case of ischemic tongue necrosis occurred in a patient with essential thrombocytosis 17. A third reported entity was rheumatoid hyperviscosity syndrome, characterized by a high rheumatoid factor and a polyclonal gammopathy that led to a hypercoagulable state 18…”

Section: Discussionmentioning

confidence: 99%

Ischemic necrosis of the tongue in patients with cardiogenic shock

2010

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Objectives/Hypothesis Ischemic necrosis of the tongue is a rare entity generally associated with vasculitis. Critically ill patients with shock might experience hypoperfusion of head and neck end organs including the tongue. Study Design Retrospective analysis of hospital charts. Methods Case histories and photographs of five patients who developed ischemic tongue necrosis in the context of cardiogenic shock. Results Five critically ill patients in our institution’s cardiothoracic intensive care unit developed ischemic necrosis of the tongue. All five patients experienced protracted courses of profound cardiogenic shock requiring high-dose vasopressor support and urgent cardiac surgery. Three patients required intraaortic balloon pumps. All patients had concomitant signs of poor end organ perfusion, including lower extremity ischemia and renal and hepatic failure. Ultimately, four of five patients died, with one patient surviving after sloughing of the entire oral tongue. Conclusions Ischemic necrosis of the oral tongue is an uncommon but perhaps under-reported manifestation of end organ hypoperfusion in shock, likely signifying poor prognosis.

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“…This rich vascular supply makes tongue necrosis exceptional. Tongue necrosis has been reported in giant cell arteritis, Wegener's granulomatosis, malignant tumors, previous radiation to the neck, intraarterial injections, emboli, ergotism, essential thrombocytosis, and calciphylaxis [1][2][3]5]. We report a case of tongue necrosis due to a combination of different vasoconstrictive agents in the intensive care setting.…”

Section: Introductionmentioning

confidence: 99%