SWOLLEN TONGUE
Swollen tongue (macroglossia) is an uncommon complaint, yet on
examination, it is occasionally found. Is it possible to think of more than
two or three causes? In most instances this is difficult, yet there is a key
to recalling the many causes.
This symptom affords the opportunity to introduce yet another method of
arriving at a differential diagnosis, the histopathologic method.
First, analyze the tissues of the tongue and then decide what can happen to
enlarge them. These tissues are the mucosa, submucosal tissue, muscle,
supporting tissue, blood vessels, and nerves. What pathologic process can
enlarge each of these? Increase in size and number of the cells; infusion of
serous fluids, pus, or blood; infiltration of a foreign protein or fat; and
infiltration of foreign cells could cause such enlargement. These are all
included in Table 54.
The mucosa can increase the number of cells in carcinoma of the
tongue. It is swollen with a serous fluid in reaction to things put in the
mouth such as hot food, mercury, and aspirin. Other less-well-understood
sources of fluid in the mucosa are erythema multiforme and pemphigus. The
submucosal and supporting tissue may be enlarged by serous
fluid in angioneurotic edema, by purulent fluid in acute diffuse glossitis
(usually caused by Streptococcus organisms), or by hemorrhagic fluid in leukemia, scurvy,
and other hemorrhage disorders. The subcutaneous and
supporting tissue can also be infiltrated by a mucoprotein in
myxedema and cretinism and by amyloid in primary amyloidosis. There may be
infiltration of neoplastic cells in leukemia and lymphoma.
The muscle hypertrophies in acromegaly. Distention of the
blood vessels may cause macroglossia in CHF and pulmonary
emphysema. A few conditions may be left out by this approach. The tongue,
for example, seems large in Down syndrome, but this is caused by the fact
that it hangs out and appears larger than it really is. The tongue is large
and smooth in riboflavin deficiency and sprue.
If the clinician prefers, an excellent differential can be achieved by using
the mnemonic VINDICATE.
Approach to the Diagnosis
The diagnosis of macroglossia depends on the presence of other physical
findings (almost invariably present) associated with the disorders mentioned
above, and, in
most cases, the results of a systematic workup. A lingual
biopsy is valuable in primary amyloidosis.
Other Useful Tests
-
CBC (leukemia)
- Sedimentation rate (glossitis)
- Culture and sensitivity (abscess, glossitis)
- VDRL test (gumma)
SYNCOPE
|
| V | I
| N | D |
|
| Vascular | Inflammatory
| Neoplasm | Deficiency or |
|
| | | | Degenerative |
|
Hypoglycemia |
|
|
Insulinoma Oat cell carcinoma |
Cirrhosis of liver |
| |
|
Lungs |
Pulmonary embolism |
Pneumonia Chronic bronchitis |
|
Pulmonary fibrosis Emphysema |
|
Blood |
|
Chronic anemia Septicemic shock |
Leukemia |
Aplastic anemia |
| |
|
Heart |
Myocardial infarction Ball valve thrombus |
Syphilitic aortitis |
Atrial myxoma |
Myocardiopathy |
Carotid Arteries |
Thrombosis Embolism |
|
|
Atherosclerosis |
|
Arteriole |
Thrombosis |
Subacute bacterial endocarditis |
|
- Thyroid profile (hypothyroidism)
- Growth hormone assay (acromegaly)
- Skull x-ray (screen for pituitary adenoma)
- Blood smear (leukemia)
- Circulation time (CHF)
- Tests for vitamin deficiency
- Coagulation studies (scurvy, leukemia)
- Lingual biopsy (amyloidosis)
Pictures
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins MD, FACP
- Year of Publication: 2007
- Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Swollen tongue
Read excerpts from these other book chapters related to Swollen tongue:
Medical Books Excerpts
- Mouth lesions
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Stomatitis
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2008 Williams & Wilkins.
More About Causes of Swollen tongue
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