Tongue infarction in suspected lingual artery thromboembolism in a cat with hypertrophic cardiomyopathy.

内容摘要

Case summary An 8-year-old, male neutered domestic shorthair cat was presented with acute onset of ataxia, apathy, hypersalivation and anorexia. Clinical examination revealed a swollen, bluish tongue tip, neurological deficits, hypothermia, hypotension and a left-sided systolic heart murmur with arrhythmia. Blood pressure was initially low but normalised after dobutamine therapy. Thoracic radiographs revealed cardiomegaly, and echocardiography confirmed a hypertrophic cardiomyopathy (HCM) phenotype with severe left atrial dilation, spontaneous echo contrast and suspected thrombus formation. MRI of the head showed absent contrast enhancement in the rostral two-thirds of the tongue and signal changes consistent with lingual infarction. Doppler ultrasound confirmed absent blood flow in the affected tongue region. Based on imaging, cardiac findings and clinical signs, a lingual artery thromboembolism was considered the most likely diagnosis. The patient was treated with anticoagulant therapy and supportive care, but because of worsening tongue swelling, functional impairment and underlying advanced heart disease, euthanasia was elected. Relevance and novel information To the authors' knowledge, this case represents the first reported case of feline arterial thromboembolism affecting the lingual artery. Although HCM was the presumed cause, other thromboembolic risk factors, such as hyperthyroidism, could not be definitively excluded. This case emphasises the need to consider atypical thromboembolic presentations in cats with cardiac disease and highlights the diagnostic value of advanced imaging modalities in identifying uncommon sites of arterial obstruction. Tongue necrosis due to a suspected arterial blood clot in a cat with hypertrophic cardiomyopathy An 8-year-old, male neutered domestic shorthair cat was examined because of a sudden onset of poor coordination, lethargy, excessive drooling and refusal to eat. On clinical examination, the tip of the tongue was swollen and blue in colour, suggesting poor blood supply. The cat also had low body temperature, low blood pressure, abnormal heart rhythm and a heart murmur. Imaging of the chest and heart showed severe heart disease consistent with hypertrophic cardiomyopathy, including marked enlargement of the left atrium and changes suggesting an increased risk of blood clot formation. Advanced imaging of the head demonstrated a lack of blood supply to the front portion of the tongue, consistent with tissue death (infarction). Doppler ultrasound confirmed the absence of blood flow to the affected area of the tongue. Based on the clinical signs, imaging findings and underlying heart disease, a blood clot blocking the lingual artery was considered the most likely cause of the tongue infarction. Despite treatment with anticoagulant medication and supportive care, the tongue swelling progressed, leading to severe functional impairment. Given the poor prognosis associated with both the tongue injury and the advanced heart disease, euthanasia was elected. This case is the first reported instance of an arterial thromboembolism affecting the lingual artery in a cat. It highlights that blood clots in cats with heart disease can affect unusual locations and demonstrates the importance of advanced imaging techniques in identifying uncommon sites of arterial obstruction.