Adolescent Patient with Cystic Fibrosis Presents with Suspected Ludwig Angina.

A 15-year-old boy attended Emergency Department with a complaint of difficulty in breathing due to dental infection. A pulmonologist was consulted regarding the severity of the cystic fibrosis. The patient was admitted and intravenous (IV) fluids and antibiotics were given. The infected mandibular right first permanent molar tooth # 30 was extracted under IV ketamine dissociative anesthesia in the hospital setting.

Radiologic Imaging of Ludwig Angina in a Pediatric Patient.

Ludwig angina is an important disease with deadly consequences. Especially in the pediatric patient group, recognition of the disease may be difficult due to patient incompatibility. For this reason, radiologic imaging methods should be carefully selected. Diffusion-weighted magnetic resonance imaging and contrast-enhanced examinations are the most important methods for the diagnosis of the disease.

Post-mortem CT findings in a case of necrotizing cellulitis of the floor of the mouth (Ludwig angina).

Ludwig angina is a rare but potentially lethal infection of the submandibular space that can cause significant upper airway obstruction. We report a case of undiagnosed Ludwig angina that progressed rapidly to death. Ludwig angina was suspected after post-mortem computed tomography (PMCT) found swollen mylohyoid muscle with stranding in subcutaneous fat, thickening of deep fascia, and local lymphadenopathy. Subsequently, an autopsy revealed woody induration of the submental region and liquefactive necrosis of the mylohyoid muscle, confirming the diagnosis. It is likely that the dental abscess identified on PMCT was the source of infection. Multiple invasive medical procedures were performed on the subject by the ambulance crew prior to his death. PMCT assisted further in determining procedural success.

Ludwig's angina in a 76-year-old man.

This case is of a 76-year-old man who presented to the emergency department with a 24-h history of a progressive tense, tender midline neck swelling. A computed tomography scan revealed Ludwig's angina and the patient went on to develop respiratory compromise and was admitted to the intensive care unit. The patient's clinical course later became complicated by abscess formation requiring drainage under general anaesthetic. He was eventually discharged home some 9 days after his initial presentation. The emergency medicine management issues surrounding Ludwig's angina are discussed briefly. This case highlights the dynamic airway changes seen in this uncommon condition. Whereas Ludwig's angina has previously been associated in the emergency medicine literature with a younger age group and in patients with a history of dental infection or treatment, this case highlights the fact that it may occur despite these two common associations.

Unusual outcome of Ludwig's angina.

This is a report of 2 cases of Ludwig's angina. An Indonesian young female patient developed severe stridor after oral examination. Then she underwent tracheostomy and developed post decannulation dyspnea due to huge surgical emphysema. The second case regards an Indian young male who developed disseminated intravascular coagulation and died from hemorrhage. The objectives of our cases presentation are to avoid mouth examination of Ludwig's angina if we are not ready for performing tracheotomy and to be aware of the possible development of disseminated intravascular coagulation and post decannulation emphysema.

Bedside ultrasound of the soft tissue of the face: a case of early Ludwig's angina.

A case is reported of a 38-year-old man presenting with early Ludwig's angina. It is difficult to differentiate superficial from deep infections of the face and neck by physical examination alone. The diagnosis of this condition with bedside soft tissue ultrasound of the face is described. Ludwig's angina is an uncommon infection of the deep tissues of the face and neck that usually evolves from more superficial infections such as dental abscesses.

Ludwig's angina: an uncommon cause of chest pain.

A 71-year-old male with coronary artery disease, hypertension, diabetes mellitus, tobacco and opioid dependence came to the emergency room complaining of one episode of retrosternal chest pain oppressive in nature of one day of evolution. He had acute respiratory distress and required mechanical ventilation. The initial impression was myocardial ischemia, but electrocardiography and cardiac enzymes ruled it out. During the following hours, neck and tongue edema developed. He was started on broad-spectrum antibiotics empirically. Neck computed tomography scan revealed a left parapharyngeal and submandibular abscess. The abscess was drained. The source of infection was found on the second molar of the left lower jaw. The patient improved and was successfully weaned from mechanical ventilation. Despite advances in therapy, Ludwig's angina remains a potentially lethal infection in which early recognition plays a crucial role.

Management of Ludwig's angina with small neck incisions: 18 years experience.

OBJECTIVE: To review Ludwig's angina medical and surgical approach with small incisions. STUDY DESIGN: Retrospective, open, noncomparative, longitudinal. METHODS: All patients with Ludwig's angina who received medical, metabolic, airway management, and surgical treatment from January 1, 1983 to December 31, 2000. STUDIED PARAMETERS: Antibiotic treatment, surgical treatment, hospitalization time, associated diseases, etiologic factors, recuperation time. RESULTS: Age range was 18 to 87 years, with a female-to-male ratio of 1.1:1 (68 females, 53 males). Thirty patients belonged to middle or high socioeconomic status. The primary site of infection was odontogenic in 107 of the patients. All the patients were managed with surgical drainage made within the first 12 hours after hospital admission. The most common antibiotic treatments were the combination of clindamycin with crystalline penicillin G. The hospital stay for more than half of patients was 6 days or less. In 62 patients we found extension into the parapharyngeal space and in 32 cases we found retropharyngeal extension of the Ludwig's angina. Forty-six patients had or were diagnosed as having diabetes mellitus. Tracheotomy was required in 34 patients. The airway of the rest of patients was controlled with nasotracheal intubation. Only 33 patients had major complications, such as mediastinitis, sepsis, or death. CONCLUSIONS: Drainage using small incisions is a safe and effective method as part of treatment of Ludwig's angina.

[Ludwig angina: a disease of the past century. Case report]. / Angina di Ludwig: una malattia del secolo passato. Descrizione di un caso clinico.

The case of a patient with Ludwig's angina, diffuse inflammation of the submandibular and sublingual spaces, a rare but life threatening disease, is described. This disorder can develop almost always as a complication of the dental infection. Causative bacteria include many Gram-negative, anaerobic organisms, streptococci and staphylococci. The potential for rapid respiratory obstruction is the greatest concern. Other serious complications include sepsis, mediastinitis, pleural empidema, pericarditis, pericardial tamponade. A cervico thoracic CT-scan and neck RNM, were performed to determine the extent of the inflammatory lesion. Treatment consists of ensuring adequate ventilation, with tracheostomy, broad spectrum antibiotic therapy and surgical drainage of the source of infection. The patient recovered without complications.