title: Ischemic necrosis of the tongue in patients with cardiogenic shock.
abstract: OBJECTIVE
  Ischemic necrosis of the tongue is a rare entity generally associated with vasculitis. Critically ill patients with shock might experience hypoperfusion of head and neck end organs including the tongue.
  
  
  METHODS
  Retrospective analysis of hospital charts.
  
  
  METHODS
  Case histories and photographs of five patients who developed ischemic tongue necrosis in the context of cardiogenic shock.
  
  
  RESULTS
  Five critically ill patients in our institution's cardiothoracic intensive care unit developed ischemic necrosis of the tongue. All five patients experienced protracted courses of profound cardiogenic shock requiring high-dose vasopressor support and urgent cardiac surgery. Three patients required intra-aortic balloon pumps. All patients had concomitant signs of poor end organ perfusion, including lower extremity ischemia and renal and hepatic failure. Ultimately, four of five patients died, with one patient surviving after sloughing of the entire oral tongue.
  
  
  CONCLUSIONS
  Ischemic necrosis of the oral tongue is an uncommon but perhaps under-reported manifestation of end organ hypoperfusion in shock, likely signifying poor prognosis.
authors.affiliation: Department of Otolaryngology, New York University Medical Center, New York, New York 10016, USA.
authors.forename: Benjamin R
authors.initials: BR
authors.lastname: Roman
authors.forename: Sara B
authors.initials: SB
authors.lastname: Immerman
authors.forename: Luc G T
authors.initials: LG
authors.lastname: Morris
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007511:Ischemia / Q000209:etiology*; D008297:Male; D009336:Necrosis; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000150:complications* / Q000628:therapy; D014059:Tongue / Q000098:blood supply* / Q000473:pathology*