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Education  |   November 2014
Images in Anesthesiology: Pediatric Tongue Injury after Transesophageal Echocardiography for Cardiac Transplantation
Author Notes
  • From the Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minnesota (M.D.F.).
  • Address correspondence to Dr. Fritock: fritock.maria@mayo.edu
Article Information
Education / Images in Anesthesiology / Cardiovascular Anesthesia / Pediatric Anesthesia / Radiological and Other Imaging
Education   |   November 2014
Images in Anesthesiology: Pediatric Tongue Injury after Transesophageal Echocardiography for Cardiac Transplantation
Anesthesiology 11 2014, Vol.121, 1091. doi:10.1097/ALN.0b013e3182a9b054
Anesthesiology 11 2014, Vol.121, 1091. doi:10.1097/ALN.0b013e3182a9b054
A 13-yr-old female with congenital heart disease underwent cardiac transplantation. Postoperatively, the patient was noted to have edema and ulceration of her tongue (fig. A) following the intraoral course of the transesophageal echocardiography probe. The injury extended linearly, from the mid portion of the left anterior tongue to the right posterior tongue base and uvula. No airway compromise was noted at extubation, but the patient reported severe odynophagia. Her symptoms improved by the fourth postoperative month despite a persistent scar (fig. B).
Postoperative glossal edema has been reported in children1,2  after sitting neurosurgical procedures and in adult cardiac surgery with transesophageal echocardiography.3  Glossal compression can impair tissue perfusion and venous drainage, causing ischemia and edema.3  In severe cases, airway obstruction can occur, and necrotic tissue may require debridement.
This patient’s injury likely resulted from compression after prolonged (8 h) transesophageal echocardiography. Low preoperative cardiac output compounded by hypothermia (34 °C) during cardiopulmonary bypass may have predisposed to ischemia. Suggested preventative measures include downsizing transesophageal echocardiography probes for lengthy procedures, gentle repositioning of the probe at regular intervals, and timely removal in the postbypass period.
Competing Interests
The authors declare no competing interests.
References
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Kuhnert, SM, Faust, RJ, Berge, KH, Piepgras, DG Postoperative macroglossia: Report of a case with rapid resolution after extubation of the trachea.. Anesth Analg. (1999). 88 220–3 [PubMed]
Sriram, K, Khorasani, A, Mbekeani, KE, Patel, S Tongue necrosis and cleft after prolonged transesophageal echocardiography probe placement.. Anesthesiology. (2006). 105 635 [Article] [PubMed]