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Ludwig's Angina Imaging - Oral Cavity Radiology

last modified on: Fri, 02/16/2024 - 15:22

See: Submandibular Gland Anatomy: The Uncinate Process of the Deep Lobe and Anatomy of submandibular gland and duct

  • Rapidly spreading infection which involves the floor of the mouth
  • Leading cause of mortality in patients is airway compromise; mortality is as high as 50% in untreated patients (Bridwell et al. 2020)
  • Odontogenic infection is the biggest risk factor but Ludwig's angina may also be associated with immunosuppresion, malnutrition, injection drug use, chronic alcohol use, and others (Bridwell et al. 2020)
  • Common signs and symptoms include odynophagia, edema, and trismus (Gunawan et al. 2022)
  • Typically polymicrobial with the most common bacteria involved being Viridans streptococci, Staph aureus, and Staph epidermidis (Bridwell et al. 2020)
  • Important to define spaces involved
    • Sublingual: superomedial to mylohyoid, may be bilateral
    • Submandibular: inferolateral to mylohyoid
    • Root of tongue: midline between the genioglossus muscles
  • Treatment involves airway intervention, broad-spectrum antibiotics, and surgical source control (Bridwell et al. 2020)
  • CT with IV contrast is imaging of choice with sensitivity of 95% and specificity of 53% (Bridwell et al. 2020)
  • On CT: rim-enhancing with contrast, cellulitis may be present, subcutaneous edema and fat-stranding present
  • On MR: On T1 mandibular marrow has low signal at infection site; on T2 high signal in abscess; on T1 post-contrast rim-enhancement

References

Bridwell R, Gottlieb M, Koyfman A, Long B. Diagnosis and management of Ludwig's angina: An evidence-based review. Am J Emerg Med. 2021 Mar;41:1-5. doi: 10.1016/j.ajem.2020.12.030. Epub 2020 Dec 23. PMID: 33383265.

Romero J, Elkattawy S, Romero A, Latif A, Al-Fiky E, Al-Nasseri A, Noori MA, Al-Alwani K. Ludwig's Angina. Eur J Case Rep Intern Med. 2022 Jun 1;9(6):003321. doi: 10.12890/2022_003321. PMID: 35821904; PMCID: PMC9267709.

Gunawan F, Ferriastuti W. Ludwig's angina: An alarming radiology challenge. Radiol Case Rep. 2022 Jun 24;17(9):3103-3106. doi: 10.1016/j.radcr.2022.05.085. PMID: 35784784; PMCID: PMC9240957.