Lingual artery thromboembolism – unusual presentation of atrial fibrillation
The lingual artery is located between the thyroid and facial arteries, and branches from the external carotid artery. The artery supplies to the oral floor and the tongue. Infarction and necrosis of the tongue is, therefore, an extremely rare phenomenon because of its abundant vasculature. In this article, we report the case of an 83-year-old woman with unilateral lingual-artery thromboembolism, secondary to atrial fibrillation.
Literature review states that there are currently no oral documented cases of oral presentation of atrial fibrillation. The previously asymptomatic 83-year-old woman presented to the emergency department with a 1-day history of swelling on the right side of her tongue with submandibular swelling. The patient had a medical history of hypertension and hypothyroidism.On examination, a smooth, swollen and erythematous tongue was notable with well-demarcated, dark discolouration on the right side. Although, there were no signs of paraesthesia. No abnormalities were seen in the oral cavity, pharynx or larynx.
Investigation findings
For further evaluation, doctors advised blood tests which showed raised inflammatory markers. Other investigations included, nasendoscopy, orthopantomogram and an ultrasound of the salivary glands. The findings of these tests were unremarkable.
The patient was continuously tachycardic, which prompted the need of an electrocardiogram, revealing atrial fibrillation. To confirm the diagnosis, a CT angiogram with contrast was performed, which showed hyperdensity in the right lingual artery. The findings were consistent with the diagnosis of thrombosis. Based on these findings, the patient was diagnosed with right lingual-artery thromboembolism, secondary to atrial fibrillation.
Doctors initiated the patient on anticoagulation with Warfarin and a course of Dalteparin. After 8 days of treatment, there was a complete resolution of pain, swelling and discolouration. The patient was called back for a follow-up after 6 months, no motor or sensory sequelae were noted.
In conclusion of the case study, although the association between oral presentations and atrial fibrillation is uncommon, there is a risk of morbidity and oral necrosis. Atrial fibrillation, otherwise, has a well-documented connection to thrombus formation and embolism in the brain, stasis of blood and strokes.
References
Lingual-Artery Thromboembolism https://www.nejm.org/doi/full/10.1056/NEJMicm2028154
