Ludwig angina

There is extensive fat stranding and edema in the submandibular and submental spaces, slightly more on the right, and surrounding the submandibular salivary glands. Subcutaneous inflammatory changes extends superficial to the platysma, which is mildly thickened. The tongue is enlarged and edematous, with partial obliteration of the right vallecula. Fat stranding extends further posteriorly into the parapharyngeal and retropharyngeal spaces.  The submandibular glands are symmetrically enlarged and hyperenhancing, with mild prominence of the ducts. No obstructing ductal calculus is demonstrated. No focal/drainable collection.

Internal and external jugular veins are normal on both sides. Cervical carotid arteries are patent. No dental caries or periapical lucencies of the maxillary or mandibular teeth.

Several small lymph nodes are demonstrated, including several hyperenhancing submental lymph nodes, although none are abnormally enlarged (the largest are being 5 mm).

No paravertebral inflammatory changes demonstrated. Cerclage wires around the C1 and C2 posterior elements from previous fusion. No suspicious osseous lesions.

A loculated left hydropneumothorax has been partially imaged.

Conclusion

Trans-spatial fat stranding centered on the submandibular and sublingual spaces and involving subcutaneous fat superficial to the platysma, without a focal or drainable collection, which in the appropriate clinical context represents Ludwig angina. No clear source is demonstrated. Enlargement, hyperenhancement and prominent ducts in the submandibular glands are likely reactive, with no calculus demonstrated.