Presentation
History of a dental procedure, presented with diffuse upper neck swelling.
Patient Data
Evidence of diffuse soft tissue edema or thickening with diffuse loss of fat plans (cellulitis) was noted at the upper neck, namely (the floor of the mouth, both submandibular, sublingual, and submental spaces), with lesser extension to the lower neck. Emphysematous changes are noted in both submandibular regions and mostly involve submandibular glands with diffuse fatty stranding, suggesting emphysematous inflammatory changes.
Multiple enlarged cervical lymph nodes are noted, the largest in both upper cervical groups.
Bilateral mandibular caries and evidence of tooth extraction were noted.
IMPRESSION:
The CT finding demonstrates diffuse soft tissue emphysematous inflammatory changes, suggesting Ludwig angina for clinical correlation.
Marked progressive changes of previously noted inflammatory emphysematous changes in the form of diffuse soft tissue edema or thickening with diffuse loss of fat plans (cellulitis) noted extended to retropharyngeal, para-pharyngeal spaces with extension to the lower neck, anterior chest wall, descending anterior and posterior mediastinum (mediastinitis), and till the level of tracheal bifurcation with multiple variable-size abscesses formation with air bubbles located within.
Multiple enlarged cervical lymph nodes are noted.
left upper lobe reticulonodular infiltration with ground glass opacities
Left pleural effusions with small encysted pleura effusions are seen with marginal enhancement and possible empyema.
Case Discussion
This patient demonstrates a typical presentation, a typical clinically widespread upper neck infection after a dental procedure, and the radiological features of Ludwig's angina, with emphasis on the role of CT in the diagnosis and follow-up of complications.
Ludwig's angina is a rare and potentially life-threatening condition characterized by a rapidly spreading infection involving the neck's submandibular, sublingual, and submental spaces. In this case, the infection progressed rapidly with necrotizing deep soft tissue infection extending throughout the neck to the upper thorax.
Case courtesy of Dr Mostafa Elshimy, Dr Ahmad Khalil, and Dr Safwat Almoghazi.
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