Journal article
From routine to ruin: an astonishing computed tomography scan reveals catastrophic Ludwig’s angina and necrotizing mediastinitis after a simple dental procedure
European journal of case reports in internal medicine
03 Apr 2025
Abstract
Ludwig’s angina is a rare, life-threatening cellulitis of the submandibular space, if unchecked, can rapidly progress to severe complications such as necrotizing mediastinitis, a condition with significant morbidity and mortality. We report the case of a 32-year-old male who developed this rare complication following wisdom tooth extraction. The patient presented with throat swelling and hematemesis, and contrast-enhanced computed tomography (CT) imaging had a decisive role in capturing the full extent of the infection, revealing severe airway narrowing, mediastinal free air, and a suspected superior vena cava thrombus. These imaging findings shaped critical clinical decisions, leading to urgent surgical drainage performed jointly by thoracic and ear, nose and throat teams along with aggressive therapy. CT not only guided treatment but also provided a roadmap for tracking disease resolution and detecting complications. Despite severe systemic involvement, including sepsis and hypotension, the patient responded well to a targeted antimicrobial regimen and supportive care. This case highlights the importance of multidisplinary work in such extensive cases, and emphasizes how radiology is more than a diagnostic tool and is an active force in shaping the management and outcome of complex infections, allowing for precise intervention before irreversible complications arise.
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Details
- Title
- From routine to ruin: an astonishing computed tomography scan reveals catastrophic Ludwig’s angina and necrotizing mediastinitis after a simple dental procedure
- Creators
- Amer Abu-Shanab - Monmouth Medical CenterAnoohya Vangala - Monmouth Medical CenterZain Albdour - University of JordanHamzeh Nasr - Monmouth Medical CenterMalay Rathod - Monmouth Medical CenterDoantrang Du - Monmouth Medical Center
- Publication Details
- European journal of case reports in internal medicine
- Publisher
- European Federation of Internal Medicine
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Pediatrics
- Scopus ID
- 2-s2.0-105004598052
- Other Identifier
- 991022047277604721