Rare Case of Tongue Ischemia Following Cardiopulmonary Bypass

Abstract

Tongue ischemia is a devastatingly rare disease complication that is typically attributed to cranial arteritis, vasculitis, or prolonged oral intubation that manifests in a patient as a phenotypically black or discolored tongue. There have been less than 10 cases reported in the literature, however, documenting tongue ischemia secondary to shock states requiring high-dose vasopressor support. In these cases, the ischemia or necrosis has typically been limited to the tip of the tongue or has been associated with unilateral disease as bilateral tongue involvement is unlikely given the collateral blood supply of the tongue. To date, the use of imaging modalities to confirm lingual artery disease as the etiology for the presentation of tongue ischemia has been limited. We present a unique case of bilateral tongue ischemia following the use of cardiopulmonary bypass which was confirmed with radiographic evidence demonstrating bilateral lingual artery disease. The nature of case is presented, previous reports of similar cases are reviewed, and potential etiologies of this rare manifestation are discussed.

Keywords: Cardiopulmonary bypass; Critical care; Shock; Tongue ischemia.

Figure 1

Bilateral ecchymosis of the patient’s tongue noted on exam.

Figure 2

CT angiogram findings of a completely occluded right lingual artery with mild distal collateral flow (circles 1 and 2) and left lingual artery with multifocal irregularities (circle 3). CT: computed tomography.