Ludwig angina

Case contributed by Dr Craig Hacking


Woke up with severe tongue and throat swelling

Patient Data

Age: 40-45 years
Gender: Male

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.


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's angina. No clear source is demonstrated. Enlargement, hyperenhancement and prominent ducts in the submandibular glands are likely reactive, with no calculus demonstrated.

Case Discussion

Care must be taken whilst imaging patients with floor of mouth swelling as they can obstruct the airway when lying flat on the CT scanner table.

Ironically Ludwig, a German physician who described the condition died in 1865 from 'non specific neck inflammation' which was probably Ludwig's angina. What bad luck! I wonder how Peyroine died?

PlayAdd to Share

Case information

rID: 37849
Published: 5th Aug 2015
Last edited: 14th Aug 2019
System: Head & Neck
Inclusion in quiz mode: Included

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.