Editor—The picture case by Nasir et al in Minerva is in danger of giving a false impression.1 Sublingual varices are not unusual. They are common, and a common clinical finding (if in doubt, just ask your dentist).2 Their prevalence increases with age, with surveys indicating that they are present in up to 60% of elderly patients, in both sexes, and in different population groups.2-4
Haemoptysis has once been reported due to bleeding from varices at the base of the tongue, associated with portal hypertension, but a textbook and Medline search for spontaneous haemorrhage from sublingual varices does not show any similar reported cases to that described.5 The advice given that sublingual varices can cause subtle and potentially dangerous bleeding is based on negligible evidence. It would be unfortunate if the case depicted induced a growth of unnecessary cauterisation of sublingual varices and misled clinicians from searching for the true cause of a patient's haemoptysis.
Competing interests: None declared.
References
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