A rare case of hemilingual abscess in a 17-year-old girl: the ease of ultrasound and the advantage of MRI

Abstract

Abscess of the tongue is rare owing to the rich vascularity and muscularity of the tongue and anti-infective properties of saliva. An abscess limited only to one half of the tongue is even more rare. We report a case of hemilingual abscess in a 17-year-old girl who presented with high-grade fever and a swollen and immobile tongue. Ultrasound (US) through floor of mouth showed inflammatory changes and collection within the right half of the genioglossus muscle. Magnetic resonance imaging (MRI) confirmed this finding, and isolated right-sided involvement was identified. US-guided aspiration of the collection yielded pus that showed gram-positive cocci on microscopy. The patient was managed conservatively, and repeat US showed resolution of the abscess. The importance of US as a quick, inexpensive, and versatile imaging technique and the precision of MRI regarding the extent of abscess of tongue are stressed.

Lingual abscess in a heavy smoker

“…Anterior lingual abscesses are seen more frequently, have milder clinical courses and are more easily diagnosed. Due to the risk of airway obstruction, posterior lingual abscesses are more important [7,8].…”

“…Irregular or rotten teeth, improper denture prostheses, trauma caused by bites or foreign bodies such as fish bones, and body piercings are the most common etiological factors for the anterior abscesses [7]. It is essential to evaluate underlying medical problems and trauma.…”

Glossal Abscess: An Unusual Presentation

“…6 Over the past 40 years, approximately 70 cases of glossal abscess have been reported in the English literature. 3,[7][8][9][10] The usual symptom with which the patient presents is acute and tender swelling of the tongue. It may develop within hours or days.…”

“…Sometimes, the classical signs of odynophagia, difficulty in speech, tongue protrusion and dribbling of saliva 2 may not be present; however, the clinician must always consider it as a differential diagnosis in the case of a lingual swelling, especially when the host appears to have an impaired immune status. 3…”

Abscesso de base de língua: uma causa incomum de obstrução de via aérea

“…Embora esteja constantemente sofrendo traumas, a língua é resistente à infecção e isso ocorre devido aos mecanismos de defesa, como rica vascularização e drenagem linfática, anatomia muscular única, constante mobilidade e a ação imunológica salivar. 3,4 O abscesso de língua é uma entidade incomum com poucos casos descritos na literatura, o qual tem um grande potencial de risco à vida por comprometer a via aérea e disseminação dos agentes patológicos para outras regiões, constituindo um desafio clínico 5,6 . Ocorre em todas as faixas etárias, no entanto, a maior parte dos pacientes encontra-se entre a faixa de 30 a 50 anos, não ocorrendo predileção por gênero 7 .…”