Ludwig angina

Case contributed by Dr Craig Hacking

Presentation

Woke up with severe tongue and throat swelling

Patient Data

Age: 44
Gender: Male
CT

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 oedematous, 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 and normally 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 centred 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 describe 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
Case created: 24th Jun 2015
Last edited: 8th Nov 2015
System: Head & Neck
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

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

Alert accept Thank you for updating your details.