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

Abstract

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.