Amin Dhara P, Cooper Michael N, Newton Kim I
Department of Emergency Medicine, Cook County (Stroger) Hospital, Rush Medical College, Chicago, Illinois.
Tulane School of Medicine, New Orleans, Louisiana.
J Emerg Med. 2018 May;54(5):e101-e103. doi: 10.1016/j.jemermed.2017.12.053. Epub 2018 Feb 13.
Lingual hematoma (LH) is a relatively uncommon entity seen after both medical and traumatic etiologies. Regardless of the cause, the feared complication is acute airway obstruction.
Our case involves a 39-year-old man who presented to the Emergency Department via emergency medical services with an enlarging LH after an unwitnessed fall, suspected to be an alcohol withdrawal seizure. The bleeding was likely exacerbated by previously undiagnosed thrombocytopenia. Airway stabilization was rapidly established via nasotracheal intubation after standard intubation techniques were deemed unfeasible. Despite correction of the coagulopathy, the LH continued to expand, resulting in bilateral tympanomandibular joint (TMJ) dislocations. To our knowledge, this complication has not been previously reported as a complication of LH. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Despite being a relatively uncommon condition, LH has the potential to result in life-threatening airway obstruction with limited airway options. Prompt airway stabilization should be the first priority upon diagnosis. A rapidly evolving LH can limit standard orotracheal rapid sequence intubation options, and may require alternative airway procedures. Additionally, ongoing lingual swelling after airway stabilization has now been shown in our case to result in bilateral TMJ dislocations. Concurrent management of reversible coagulopathy may help prevent this complication or reduce its severity.
舌部血肿（LH）在医学及创伤性病因后均较为少见。无论病因如何，令人担忧的并发症是急性气道梗阻。
我们的病例是一名39岁男性，通过紧急医疗服务被送往急诊科，在一次无人目睹的摔倒后出现舌部血肿且不断增大，怀疑是酒精戒断性癫痫发作。出血可能因先前未被诊断出的血小板减少症而加重。在标准插管技术被认为不可行后，通过鼻气管插管迅速建立了气道稳定。尽管纠正了凝血功能障碍，但舌部血肿仍继续扩大，导致双侧颞下颌关节（TMJ）脱位。据我们所知，这种并发症此前尚未被报道为舌部血肿的并发症。为什么急诊医生应该了解这一点？：尽管舌部血肿相对少见，但它有可能导致危及生命的气道梗阻，且气道选择有限。诊断后应立即优先稳定气道。迅速进展的舌部血肿会限制标准的经口气管快速顺序插管选择，可能需要采取替代气道操作。此外，在我们的病例中，气道稳定后持续的舌部肿胀现已显示会导致双侧颞下颌关节脱位。同时处理可逆性凝血功能障碍可能有助于预防这种并发症或减轻其严重程度。
