3rd Place EMage Winner-The Tall Tongue

Christopher Redgate, MD, MS

Kelly Kelley, MSN, RN, CPNP, CNS

Manpreet Singh, MD, MBE

Pediatric Emergency Department, Department of Emergency Medicine, Harbor-UCLA

A 13-year-old female patient presented to the emergency department (ED) for left eye pain. A clinician noted prominence in the left side of her tongue (Picture 1). Further history revealed progressive tongue swelling during the prior year along with throat fullness and “discomfort.” At that time, an Otolaryngologist (ENT) stated she had an “enlarged tongue” but subsequent follow-ups were not pursued. Since then, she developed loud snoring with no voice changes or dysphagia.

On examination, the swelling on the left dorsum of the tongue body was noted to have displaced the tongue superiorly and contralaterally. The swelling also extended into the posterior oropharynx, passing the uvula and partially obscuring the left palatopharyngeal arch (Picture 2). Swelling on the ventral surface of the left tongue root extended laterally to the mandible.

A CT revealed a 4.2 x 3.4 x 2.5cm oval, thin-walled cystic lesion within the sublingual space which displaced the genioglossus medially and mylohyoid muscle laterally, causing mass effect upon the oropharynx (Figures 3, 4, 5). Additionally, ophthalmology diagnosed her with unrelated dry eye syndrome. Her ENT follow up appointment is pending.

Picture 1

Picture 2

Picture 3

 

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