Idiopathic spontaneous sublingual hematoma: a case report and literature review

Purpose Sublingual hematoma is a rare complication seen in bleeding disorders, trauma, dental procedures, and the use of anticoagulants. Only a few publications have described idiopathic spontaneous sublingual hematoma, and all of them suspected severe hypertension as etiology. Our objective is to present a case of idiopathic spontaneous sublingual hematoma in a 48-year-old patient without any medical history of hypertension and to perform a literature review on this subject. Methods Case report presentation based on information extracted from the electronic patient database of Ghent University Hospital including a literature review of sublingual hematoma. Results This case report describes a 48-year-old male patient presenting with a spontaneous sublingual hematoma, which needed to be treated with an urgent tracheotomy. Drainage of the old hematoma followed 11 days later. He was not known with hypertension or any bleeding disorder. Clinical examination using fiberoptic nasolaryngoscopy, a CT scan, MRI scan, and biopsy of the sublingual salivary gland showed no focus for etiology. Conclusions Clinical work-up is necessary to look for a cause of a spontaneous sublingual hematoma. Idiopathic spontaneous hematoma is only a rare entity. Aggressive airway management should be the first step in treatment. To date, there is no consensus about the management regarding the hematoma itself. Mostly, clinicians start with observation for spontaneous resolution of the hematoma and when possible to treat causative factors. Surgical drainage is performed when conservative treatment is not sufficient.