PMC5447390_01
Oral examination showing significant floor of mouth with swelling and hemorrhagic changes.
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Creatinine was slightly elevated to 117 (49-90 umol/L) (Fig. 1).
(A) Axial image through the hyperdense mass within the floor of mouth confined to the sublingual space "arrows", associated with heterogeneous submandibular gland enlargement posterolaterally within the submandibular space "arrowhead". (B, C) Sagittal and coronal images through the lesion "arrows" demonstrates significant mass effect on the adjacent tongue "curved arrows" and endotracheal tube "arrowhead", associated with moderate reactive subcutaneous inflammatory fat stranding in the adjacent submental space "open arrowhead". Note the mylohyoid muscles "curved arrowhead in C" separating the lesion from the submental space inferiorly and the submandibular space posterolaterally.
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Unenhanced and enhanced CT scan of the neck demonstrates large heterogeneous nonenhancing mass at the floor of the mouth confined within the sublingual space (straight arrows in Fig. 2) which measures approximately 3.3 x 3 x 2.6 cm in three dimensions. No convincing extension to the adjacent submental or submandibular space beyond the visualized mylohyoid muscles bilaterally (arrowhead in Fig. 2C). It demonstrates significant adjacent superior mass effect on the adjacent tongue (curved arrow in Fig. 2), and the endotracheal tube superolaterally (arrowhead in Fig. 2B and C). There is a significant adjacent inflammatory fat stranding within the submental space subcutaneous fat inferiorly (open arrowhead in Fig. 2B and C), with submandibular glands heterogeneous enlargement posterolaterally within the submandibular space (arrowhead in Fig. 2A).
(A) CTA axial images through the lesion demonstrate no convincing active extravasation of the IV contrast from the lingual arteries bilaterally "arrows". The rest of the visualized external carotid artery branches are within the normal limits as well. (B, C) Coronal and sagittal images through the lingual arteries "arrows" didn't show any underling abnormal tangle of vessels or arterial pseudoaneurysm to suggest underling vascular pathology.
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The CTA images demonstrate normal morphology and opacification of lingual arteries bilaterally, with no evidence of abnormal tangle of vessels or arterial pseudoaneurysm to suggest underlying vascular pathology (Fig. 3).
Ongoing floor of mouth swelling after intubation. Notice the skin changes with ecchymosis and bruises that lags few days from the onset of the symptoms (A, B). Marked improvement and reduction in the swelling after few days of intubation, skin bruises worsen before start improving (C).
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She was followed up 6 weeks after discharge with complete resolution of the swelling and ecchymosis (Fig. 4).