Lingual haematoma after treatment with alteplase (recombinant tissue plasminogen activator) for acute myocardial infarction.

A 69 year old previously healthy man was admitted with a 40 minute history of chest pain. The electrocardiograph showed evidence of an acute anterolateral myocardial infarction (MI). He was treated with soluble aspirin (300 mg), heparin (5000 units bolus), alteplase (rtPA) (100 mg), and heparin infusion (1000 units/h). An hour and 50 minutes later he complained of a dry mouth and examination showed considerable swelling and discolouration of the tongue and floor of the mouth, with the tongue occupying about 75% of the oral cavity. The appearances were consistent with