Computed tomography imaging of Ludwig's angina

Congress:

ECR 2019

Poster Number:

C-0743

Type:

Educational Exhibit

Keywords:

Inflammation, Diagnostic procedure, CT, Head and neck, Emergency

Authors:

S. Petrovic¹, F. Petrovic¹, A. Milenkovic¹, M. Petrovic¹, D. A. Stojanov², Z. Radovanovic¹; ¹Nis/RS, ²Nis, SERBIA/RS

DOI:

10.26044/ecr2019/C-0743

DOI-Link:

https://dx.doi.org/10.26044/ecr2019/C-0743

Fig. 1: Axial, coronal and sagittal postcontrast CT scans demonstrate bilateral changes...

Fig. 2: Axial postcontrast CT scans demonstrate oedema in submandibular and sublingual...

Fig. 3: Axial postcontrast CT scans demonstrate increased attenuation of subcutaneous...

Fig. 4: Axial and coronal postcontrast CT scans demonstrate late phase of Ludwig...

Fig. 3: Axial postcontrast CT scans demonstrate increased attenuation of subcutaneous...

Learning objectives

-To describe the clinical presentation of Ludwig's angina -To illustrate CT findings of Ludwing`s angina -To describe the complications associated with this disease

Background

Ludwig's angina is a serious, potentially life-threatening infection of the floor of the mouth. It is a type of phlegmonous infection of the soft tissue involving the floor of the mouth that rapidly extends bilaterally to the soft tissues of the oral cavity and neck. It involves 2 compartments on the floor of the mouth including the sublingual and submandibular space bilaterally. Wilhelm Friedrich von Ludwig first described this condition in 1836. Knowledge of neck anatomy is basic to understanding the clinical manifestations, pathogenesis, progression,...

Findings and procedure details

Patients present with symptoms of odontogenic abscess, jaw and neck swelling, elevation of the tongue, and stridor.The most common presenting symptoms include neck swelling, fever, neck pain, odynophagia, and dysphagia. People often describe the appearance as a "bull neck" and they may have "hot potato" voice-dysphonia what is suggestive to severe airway compromise. At physical examination, the submandibular tissues are firm and hard, and crepitation may be present. As soft-tissue swelling displaces the tongue into the pharyngeal airway, the patient may experience difficulty breathing or...

Conclusion

Ludwig angina is a diffuse, rapidly spreading phlegmonous infection of the soft tissues of the neck and floor of the mouth. It always involves both the sublingual and submandibular spaces. Although its incidence has declined with improvement in dental care, it remains a serious and potentially lethal clinical entity that requires prompt management to avoid serious morbidity or death from airway compromise. CT imaging plays a critical role in the diagnosis of Ludwig`s angina in the emergency setting, as well as in detecting any associated...

Personal information

Sladjana Petrovic, MD,PhD Institute of Radiology, Clinical Centre Nis, 18000 Nis Serbia e-mail: [email protected]

References

1. Wolfe MM, Davis JW, Parks SN. Is surgical airway necessary for airway management in deep neck infections and Ludwig angina? J Crit Care. 2011 Feb;26(1):11-4. 2. Robbins KT, Schuller DE, Thomas JR, editors. Otolaryngology: head and neck surgery. 4th ed. Philadelphia: Elsevier Mosby, 2005: 2515-2524 3. Marple BF. Ludwig angina: a review of current airway management. Arch Otolaryngol Head Neck Surg 1999; 125: 596-599 4. Bross-Soriano D, Arrieta-Gómez JR, Prado-Calleros H, Schimelmitz-Idi J, Jorba-Basave S. Management of Ludwig's angina with small neck incisions: 18...