DOI: 10.12890/2025_005285
From routine to ruin: an astonishing computed tomography scan reveals catastrophic Ludwig’s angina and necrotizing mediastinitis after a simple dental procedure
Authors
zainalbdour@icloud.com
Keywords
Ludwig’s angina, necrotizing mediastinitis, odontogenic infection, computed tomography, CTAbstract
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.
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;41:1-5.
- Akman C, Kantarci F, Cetinkaya S. Imaging in mediastinitis: a systematic review based on aetiology. Clin Radiol 2004;59:573-585.
- Candamourty R, Venkatachalam S, Babu MR, Kumar GS. Ludwig’s Angina - An emergency: A case report with literature review. J Nat Sci Biol Med 2012;3:206-208.
- Diamantis S, Giannakopoulos H, Chou J, Foote J. Descending necrotizing mediastinitis as a complication of odontogenic infection. Int J Surg Case Rep 2011;2:65-67.
- Scaglione M, Pinto A, Giovine S, Di Nuzzo L, Giuliano V, Romano L. CT features of descending necrotizing mediastinitis--a pictorial essay. Emerg Radiol 2007;14:77-81.
- Costain N, Marrie TJ. Ludwig’s Angina. Am J Med 2011;124:115-117.
- Prado-Calleros HM, Jiménez-Fuentes E, Jiménez-Escobar I. Descending necrotizing mediastinitis: Systematic review on its treatment in the last 6 years, 75 years after its description. Head Neck 2016;38:E2275-2283.
