Ischemic necrosis of the tongue in patients with cardiogenic shock

Abstract

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.

Ischemic Necrosis of Upper Lip, and All Fingers and Toes After Norepinephrine Use

“…Although partial lip necrosis is verified in the patient here, total tongue necrosis was reported in another study. 4 Of course, there is another possible disease for differential diagnosis like purpura fulminans. It manifests as blood spots and discoloration of the skin with necrosis and disseminated intravascular coagulations.…”

“…1 Several studies about the connection between ischemic necrosis and the use of norepinephrine have been reported. [2][3][4] However, no previous studies describe severe functional and aesthetic sequela of the upper lip and all fingers and toes after the use of norepinephrine.…”

Ischaemic necrosis of the tongue

“…Other causes such as APS may require anticoagulant treatment. In previously reported cases of extensive necrosis a conservative approach was adopted, as with our patient 5 6. These cases had a high mortality rate related to extensive comorbidities.…”

“…Other reports of lingual necrosis exist secondary to vasopressor use, radiotherapy and antiphospholipid syndrome (APS) 2–4. Reports of bilateral ischaemia are rare but have been reported in relation to severe hypotension or disseminated intravascular coagulation 5 6. We present a case of bilateral lingual ischaemic necrosis presenting in a 61-year-old patient as an acutely swollen tongue threatening the airway.…”

A Rare Case of Lingual Necrosis Secondary to Prolonged Endotracheal Intubation

“…Other mild complications of prolonged intubation include difficulty with phonation and dysphagia after extubation [9], while more serious complications include laryngeal injury and upper airway distress requiring advanced airway management [2,10]. Ischemic necrosis of the tongue in intubated patients is rare and previously reported in patients with cardiogenic shock requiring pressor support or those undergoing prolonged neurosurgical or head and neck surgeries [11,12]. In non-intubated patients, tongue necrosis has been reported with trauma, local vasculitis and rarely with transient ischemic attacks and disseminated intravascular coagulation [13][14][15].…”