Edicio Clinica Felix Boada, Calle Bolivar, Nº 59, Baruta – Caracas – Venezuela
RID
REPORTE
Imagenológico Dentomaxilofacial
Sociedad Venezolana deSociedad Venezolana de
Radiología e ImagenologíaRadiología e Imagenología
DentomaxilofacialDentomaxilofacial
SVRID
08-11-2012
ISSN: 2791-1888. e-id: e20240301 Número 1 Volumen 3 Enero -Junio 2024
Rep Imagenol Dentomaxilofacial 2024 enero-junio; 3(1): 2024030105
e-ISSN: 2791-1888|
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DOI: 10.60094/RID.20240301-36
1 de 6
REPORTE DE CASO
RESUMEN
DIAGNOSIS OF POST-TRAUMATIC ARTERIOVENOUS
FISTULA ON THE BACK OF THE TONGUE: THE
IMPORTANCE OF ULTRASONOGRAPHY
DIAGNÓSTICO DE FÍSTULA ARTERIOVENOSA
POSTRAUMÁTICA EN EL DORSO DE LA LENGUA: LA
IMPORTANCIA DE LA ECOGRAFÍA
Recibido: 24/01/2024
Aceptado: 29/04/2024
Publicado: 15/05/2024
Como citar: De Araujo Junior
AG, De Araujo LGC, Cordeiro
JM, Oliveira
GDP, Pinto
ASB. Di-
agnosis of post-traumatic arteriovenous stula on the back of the tongue: the Importance
of ultrasonography. Rep Imagenol Dentomaxilofacial 2024;3(1):e2024030105
Ayrton Galvão De Araujo Junior
1
*, Luis Gustavo Caldas De Araujo
1
, Jéssica Moreno Cordeiro
2
, Giuliano Da
Paz Oliveira
3
, Antonione Santos Bezerra Pinto
3
1
Student of Medicine. Faculdade de Ciências Humanas, Exatas e da Saúde do Piauí/Instituto de Educação
Superior
do Vale do Parnaíba (FAHESP/IESVAP). Parnaíba-PI, Brasil. dr.ayrtonjunior@hotmail.com ORCID:
0000-0003-0550-5019; lg.fla2001@gmail.com ORCID: 0009-0009-9589-1961
2
Doctor of Medicine. Faculdade de Ciências Humanas, Exatas e da Saúde do Piauí/Instituto de Educação
Superior
do Vale do Parnaíba (FAHESP/IESVAP). Parnaíba-PI, Brasil. jessicamoreno2013@hotmail.com ORCID:
0000-0002-2954-2968
3
Professor of the Medicine course. Faculdade de Ciências Humanas, Exatas e da Saúde do Piauí/Instituto de
Educação Superior do Vale do Parnaíba (FAHESP/IESVAP). Parnaíba-PI, Brasil. giuliano.oliveira@iesvap.edu. br ORCID:
0000-0002-3141-0032; antonione.pinto@iesvap.edu.br ORCID: 0000-0002-6577-2816
Academic editor: Dra. Ana Isabel Ortega.
Las fístulas arteriovenosas (FAV) son anomalías vasculares que pueden ocurrir después de un
traumatismo en diferentes partes del cuerpo, incluida la cavidad bucal, estas anomalías pueden
desencadenar varias consecuencias para el individuo afectado. Dicha anomalía puede clasicarse en
adquirida, generalmente después de algún traumatismo o hemodiálisis, y congénita. Su diagnóstico,
a su vez, es fundamental para el manejo del paciente, evitando complicaciones clínicas. En la cavidad
bucal, aunque poco frecuente, puede afectar, especialmente, al dorso de la lengua. La ecografía es
una técnica de imagen que puede ser útil en el diagnóstico de FAV en la lengua. Esta técnica permite
visualizar estructuras vasculares en tiempo real, evaluar el ujo sanguíneo e identicar anomalías
como las FAV. El presente estudio tiene como objetivo reportar el caso de una paciente femenina de
39 años que presentó una FAV postraumática por objeto extraño en la región del dorso derecho de la
lengua. Durante la evaluación profesional fue posible utilizar la ecografía Doppler color para dilucidar
la presencia de ujo venoso y arterial en la región anormal, corroborando los hallazgos clínicos y siendo
fundamental para cerrar el diagnóstico, denotando el importante papel de este examen de imagen.
Palabras clave: Fístula vascular, boca, lengua, ultrasonografía doppler, ultrasonografía (DeCS)
Rep Imagenol Dentomaxilofacial 2024 enero-junio; 3(1): 2024030105
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POST-TRAUMATIC ARTERIOVENOUS FISTULA ON THE
BACK OF THE TONGUE
De Araujo, et al.
2 de 6e-ISSN: 2791-1888|
INTRODUCCTION
REPORTE DE CASO
Arteriovenous s
tulas (AVF) are vascular anomalies that can occur after trauma in different parts
of the body, including the oral cavity, these abnormalities can trigger several consequences for the
affected individual. Such abnormality can be classied as acquired, usually after some trauma or
hemodialysis, and congenital. Its diagnosis, in turn, is essential for the management of the patient,
avoiding clinical complications. In the oral cavity, although rare, it can affect, especially, the dorsum of the
tongue. Ultrasonography is an imaging technique that can be useful in diagnosing AVF in the tongue.
This technique allows visualizing vascular structures in real time, assessing blood ow and identifying
anomalies such as AVFs. The present study aims to report a case of a 39-year-old female patient who
presented a post-traumatic AVF caused by a foreign object in the region of the right dorsum of the
tongue. During the professional evaluation, it was possible to use color Doppler ultrasonography to
elucidate the presence of venous and arterial ow in the abnormal region, corroborating the clinical
findings and being essential to close the diagnosis, denoting the important role of this imaging exam.
Key words: Vascular fistula, mouth, tongue, doppler ultrasonography, ultrasonography (MeSH)
Arteriovenous stulas (AVF) are vascular
anomalies that can occur after trauma to various
parts of the body, including the oral cavity
1
. These
anomalous connections between arteries and
veins can be asymptomatic, but in some cases,
they can lead to serious complications, such
as bleeding, embolizations and heart failure
2
.
The AVFs can be classied in congenital and
acquired. Acquired ones, in turn, can be created
through surgical procedures, such as the need for
hemodialysis; and as a result of vascular injuries
associated with trauma or iatrogenic
3,4
Due to the rarity of the condition, there is
little literature on the exact prevalence of AVFs
in the cavity. They can develop congenitally
or acquired, with congenital originating from
failures in vascular development. Clinically, there
will be the presence of a nodular, purplish-colored
lesion with slower healing and aesthetic and/or
functional discomfort, depending on the extent
5
. AVFs mainly affect areas of intense mechanical
contact, such as the lateral border and dorsum of
the tongue. These regions are areas vulnerable
to trauma, whether due to falls or car accidents,
which is the main etiological factor of AVFs in
the tongue. Lesions in this region can affect
underlying vascular structures, leading to the
formation of AVFs
6
.
However, the diagnosis of AVF in the tongue
can be challenging, due to the difculty in
visualizing the vascular structures in this region6.
It is important to reafrm that AVFs in the tongue
are rare and early diagnosis is essential for
successful treatment
6,7
.
Ultrasonography is an imaging technique that
can be useful in diagnosing AVF in the tongue.
This technique allows you to visualize vascular
structures in real time, evaluate blood ow and
identify anomalies such as AVFs
5,7
. Ultrasound
can be performed with a linear transducer probe,
which is capable of providing high-resolution
images of the lingual region, without the need
for exposure to ionizing rays. Furthermore,
ultrasound is a non-invasive, safe and low-cost
examination compared to computed tomography
and magnetic resonance imaging, making it an
excellent alternative for this diagnosis
5
.
ABSTRACT
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POST-TRAUMATIC ARTERIOVENOUS FISTULA ON THE
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CASE PRESENTATION
This article aims to report a case of
post-traumatic AVF on the lateral border of
the tongue, highlighting the importance of
ultrasound for the nal diagnosis. The clinical
characteristics of the lesion will be discussed, as
well as the advantages of ultrasound in relation to
other imaging techniques in diagnosing AVF in
the tongue.
A 39-year-old female patient sought dental
care reporting that she had suffered trauma to
her tongue while using a toothpick. She reported
that, after the trauma, she noticed swelling in the
affected area, as well as pain and bleeding.
During the clinical examination, it was
observed the presence of a lesion located on
the right dorsum of the tongue, with a nodular
appearance, single, purplish color, measuring
approximately 0.5 x 0.3 cm in its largest diameters,
of elastic consistency, painless to palpation and
xed in relation to adjacent tissues (Figure 1A). The
patient was asked about the possibility of having
any previous history of trauma or surgery in the
region, but she denied any relevant history.
A diascopy or vitropressure maneuver was
performed using a glass slide, applying a uniform
force, where an extravasation of blood was
observed, with dispersion of hemoglobin, causing
a disappearance of the characteristic color (Figure
1B). A panoramic radiography was requested,
which did not reveal any bone abnormalities in
the region.
Next, a color Doppler was performed to assess
the nature of the AVF and its size, which allowed
conrmation of the presence of arterial and
venous blood ow in the affected area.
Figura 1. (a) Purple nodular lesion on the right dorsum of the tongue (b) Performing diascopy or vitropressure with ischemia of the
aected region.
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POST-TRAUMATIC ARTERIOVENOUS FISTULA ON THE
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De Araujo, et al.
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The examination was performed through oral
access with a high-resolution linear transducer,
revealing a hypoechoic nodular image with lobulated
contours and partially dened limits, measuring
approximately 0.45 x 0.29 cm, located in the mucosa/
submucosa topography of the right lateral border of
the tongue, anteriorly, with underlying hypoechoic
structures, composed of arterial and venous vessels
with areas of aliasing inside. Other portions evaluated
without changes (Figure 2).
The patient was referred to a specialist in
vascular surgery to perform embolization of the
artery responsible for the AVF. After the procedure,
the patient showed signicant improvement.
During clinical follow-up, it was observed that the
arteriovenous stula had completely resolved. The
patient was advised to avoid using sharp objects
in her mouth, especially toothpicks, to prevent
recurrence of such trauma and its effects.
Figura 2. Vascular hypoechoic image (Arrows) in the mucosa/submucosa topography of the right lateral border of the tongue,
anteriorly, suggesting a post-traumatic arteriovenous stula.
DISCUSSION
AVF in the oral cavity can occur in various
locations, the most common being the tongue,
lips and palate
8
. In the tongue, an AVF can occur
after trauma, as in the case of injuries caused
by toothpicks, as noted in the case in question;
or due to vascular diseases such as hereditary
hemorrhagic telangiectasia (Rendu-Osler-Weber
disease)
6,9–11
. In the lips and palate, AVFs can be
associated with traumatic injuries, such as needle
punctures, piercings and blunt trauma
8
.
The clinical case report presented is of great
importance for several reasons. Firstly, oral
Rep Imagenol Dentomaxilofacial 2024 enero-junio; 3(1): 2024030105
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POST-TRAUMATIC ARTERIOVENOUS FISTULA ON THE
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trauma with a toothpick is a relatively common
occurrence in dental practice and can result in
several complications, as in the case of the patient
in question who developed AVF in the tongue
9,10
.
Ultrasonographic evaluation is essential for the
accurate diagnosis of oral lesions, as demonstrated
in this clinical case. The fact that it offers a high
quality and radiation-free image; real-time
images; ease of access and low cost are criteria
that make this method eligible compared to
others
5,7
. Color Doppler is an ultrasound technique
that allows you to evaluate blood ow in real time,
which is especially useful for detecting AVFs. The
examination showed that the lesion was vascular,
with arterial and venous blood ow, conrming
the diagnosis of AVF
5
.
The patient presented with a nodule on the
right lateral edge of the tongue, which was initially
attributed to trauma with a toothpick. However,
ultrasound evaluation revealed the presence of
AVF, which is an anomalous communication
between an artery and a vein
8,11
.
Embolization of the artery responsible for the
AVF is an effective procedure for treating this
condition, as was performed in this patient. The
importance of ultrasound evaluation is evident in
this case, as the lesion was not easily identied on
clinical examination, but was promptly diagnosed
by ultrasound
5,7,12
.
This case highlights the importance of careful
evaluation of oral lesions, especially in patients
who report trauma or have lesions that do not
improve after initial treatment. Ultrasonography is
a valuable tool for diagnosing oral vascular lesions,
such as AVF, and should be considered as part of
the initial evaluation of these patients
5
.
AVFs, although rare in the oral cavity, can occur
and lead to important clinical repercussions,
depending on the magnitude. Its diagnosis is
related to the levels of progression of the disease
and must therefore be carried out quickly and
accurately. The use of Doppler ultrasonography
plays an important role in this dynamic, allowing
the visualization of vascular structures in a dynamic
and safe way, allowing vascular assessment in real
time. The approach taken by this work contributes
signicantly to the differential diagnosis aspects
of this condition. We believe that new studies
must be carried out, aiming at uniformity and
CONCLUSIONS
deepening the clinical approach to diagnostic
methods.
Conict of interest: The authors declare that they
have no conict of interest with this work.
Corresponding author:
Ayrton Galvão de Araujo Junior. Av. Coronel
Francisco Moreira, 27, Centro, Santa Quitéria do
Maranhão - MA. Faculty of Ciências Humanas,
Exatas e da Saúde do Piauí/Instituto de Educação
Superior do Vale do Parnaíba (FAHESP/IESVAP).
Parnaíba-PI. Brasil. dr.ayrtonjunior@hotmail.com
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Rep Imagenol Dentomaxilofacial 2024 enero-junio; 3(1): 2024030105
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POST-TRAUMATIC ARTERIOVENOUS FISTULA ON THE
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