Spontaneous submental hematoma, a pseudo-Ludwig’s phenomenon in 101-year-old patient: case report and literature review
Bibliographic record
Abstract
OBJECTIVE: Submental hematoma or pseudo-Ludwig's phenomenon, is a rare entity seen in anticoagulated patients and can precipitate upper airway obstruction. Our objective is to present a rare case of spontaneous submental hematoma due to poorly controlled hypertension in elderly patient and to perform a literature review. CASE REPORT: 101-year-old female presented to emergency room with sudden painful swelling in the floor of mouth and slurred speech. Not on anticoagulation and no history of trauma or known allergies. Physical examination and flexible laryngoscope revealed normal temperature and blood pressure of 190/100, submental/floor of mouth swelling that was tense to palpation, ecchymotic/hemorrhagic and extend to the tip of the tongue suggestive of recent submucosal bleeding and mild swelling at the base of tongue as well as small hemorrhagic vallecular cyst. CT scan ruled out AVM and pseudoaneurysm of lingual artery. She was diagnosed with spontaneous submental hematoma (SSH) probably due to the rupture of atherosclerotic vessels supplying the musculature related to the space due to uncontrolled sever hypertension. She was treated conservatively by electively securing the airway and the swelling resolved in 3days. She got extubated and subsequently discharged home. METHODS: Systematic literature review was conducted and revealed only 5 cases since 2002 reported with this rare subgroup of spontaneous submental hematoma not related to anticoagulation. This case report has been reported in line with the SCARE criteria [1]. RESULTS: 4 cases were results of uncontrolled hypertension whereas one case was seen in cirrhotic liver patient. One patient was managed with surgical evacuation of the hematoma were in the others conservative management initiated but failed. Of those 4, 2 required an emergent airway procedure. CONCLUSION: Spontaneous submental hematoma (SSH) is a clinical diagnosis and conservative management is successful in reducing the amount of swelling once the causative factors have been corrected/controlled. The main goal is to electively secure the airway and as in all emergent airway management the team must include members capable of a surgical airway.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".