Purpose or Case Report: Lingual tonsils are part of the Waldeyer ring, located at the base of the tongue in continuity with the palatine tonsils. Situated at the common entry of the respiratory and the digestive system, they play a pivotal role in initiating and maintaining immune response. Lingual tonsil hypertrophy (LTH) is rare in children with no comorbidities. However, an accumulating body of evidence suggests that LTH is associated with obesity and Down Syndrome, particularly in cases where palatine tonsillectomy and adenoidectomy have been performed. Recent research has indicated positive correlation between LTH and obstructive sleep apnea, which constitutes a significant cause of morbidity in children. Therefore, prompt diagnosis is critical, as a timely tonsillectomy can easily resolve this life-threatening condition. Although the role of CT and MRI in identifying LTH has been discussed in literature, there remains limited evidence concerning ultrasound’s value in its accurate diagnosis, while avoiding radiation exposure.
The following case highlights ultrasound’s reliable evaluation of the lingual tonsil and its potential position as a screening method for patients with obstructive sleep apnea.
We present a case of a 14-year-old boy with Down syndrome, who had undergone a previous palatine tonsillectomy. The patient presented with dysphagia and sleep apnea. Upon direct laryngoscopy performed by an experienced otolaryngologist, a suspicion arose of a mass adherent to the anterior surface of the epiglottis. As a result, he was referred to our radiological department for further evaluation, and an ultrasound examination was performed.
Ultrasound revealed an ovoid-shaped, well-defined mass located at the base of the tongue. The mass demonstrated a hypoechoic echogenicity, with a striated appearance consisting of alternating linear hyperechoic and hypoechoic bands. These sonographic characteristics were compatible with palatine tonsils. No residual palatine tonsillar tissue was recognized upon meticulous examination.
A dynamic, real-time examination followed, with the patient instructed to take deep breaths. The movement of the mass within the retroglossal space was observed, proving its role in obstructive apnea. Correlating the ultrasound findings with the patient’s medical history, a diagnosis of enlarged lingual tonsil was made, also demonstrated on CT and confirmed by post-surgical pathology.
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