Case 17 - Ludwig's Angina, Sialadinitis

Dr. Yousem has provided the following report as a sample report for your reference. It does not match the case reviewed in the video.

EXAM: CT NECK SOFT TISSUE W/ CONTRAST COMPLEX

INDICATION: 39-year-old gentleman with right jaw swelling since yesterday, pain, cracked tooth on the right side of mouth, concern for deep neck infection.

COMPARISON: None.

TECHNIQUE: Following IV administration of iodinated contrast, soft tissue neck CT with sagittal and coronal reformats was obtained.

FINDINGS: There is edema in the right submandibular space, tracking in the right parapharyngeal space. There is no drainable or peripherally enhancing collection.

There is mild asymmetric enlargement and differential enhancement of the right submandibular gland, which may be primarily or secondarily inflamed. Parotid glands appear normal. There is also mild asymmetric enhancement of the right palatine tonsil, without evidence of associated abscess. Diffuse cellulitis is seen in the right side of the neck with thickening of the platysma muscle as well as the anterior belly of the digastric muscle and the submental and submandibular space.

There is a cavity of the right third mandibular molar on the buccal surface of the crown, with a prominent periapical lucency, compatible with an endodontal disease. There is a small periapical lucency of the right first mandibular bicuspid as well.

Bilateral first mandibular molars are absent.

Mild asymmetric enlargement of submental and right submandibular lymph nodes, and a right level 2 lymph node measuring 1.6 x 2.5 cm, are likely reactive.

Pharynx, larynx and subglottic airway are patent.

Thyroid gland appears normal.

Normal-appearing orbits. Trace retained secretions and small mucous retention cyst in the left maxillary sinus. Mild bilateral mastoid air cell effusions.

Mild images demonstrate change in the bilateral lung apices.

No critical foraminal or canal stenosis in the cervical spine.

IMPRESSION:

Inflammatory change in the right floor of mouth and submandibular space with edema and fat stranding extending to the platysma and subcutaneous fat but no drainable fluid collection or abscess. Inflammation of the right submandibular gland, and right tonsillar pillar, likely secondary. Findings are suggestive of Ludwigs angina.

Attending note:

There is a low density region seen on series 2 image 50 anterior medial to the right submandibular gland. While this does not have peripheral enhancement and may represent a phlegmon along the anterior belly of the digastric muscle on the right side.

Case 20-2 (Ludwig's angina)

EXAM: CT NECK SOFT TISSUE W/ CONTRAST COMPLEX

INDICATION: 39-year-old gentleman with right jaw swelling since yesterday, pain, cracked tooth on the right side of mouth, concern for deep neck infection.

COMPARISON: None.

TECHNIQUE: Following IV administration of iodinated contrast, soft tissue neck CT with sagittal and coronal reformats was obtained.

FINDINGS: There is edema in the right submandibular space, tracking in the right parapharyngeal space. There is no drainable or peripherally enhancing collection.

There is mild asymmetric enlargement and differential enhancement of the right submandibular gland, which may be primarily or secondarily inflamed. Parotid glands appear normal. There is also mild asymmetric enhancement of the right palatine tonsil, without evidence of associated abscess. Diffuse cellulitis is seen in the right side of the neck with thickening of the platysma muscle as well as the anterior belly of the digastric muscle and the submental and submandibular space.

There is a cavity of the right third mandibular molar on the buccal surface of the crown, with a prominent periapical lucency, compatible with an endodontal disease. There is a small periapical lucency of the right first mandibular bicuspid as well.

Bilateral first mandibular molars are absent.

Mild asymmetric enlargement of submental and right submandibular lymph nodes, and a right level 2 lymph node measuring 1.6 x 2.5 cm, are likely reactive.

Pharynx, larynx and subglottic airway are patent.

Thyroid gland appears normal.

Normal-appearing orbits. Trace retained secretions and small mucous retention cyst in the left maxillary sinus. Mild bilateral mastoid air cell effusions.

Mild images demonstrate change in the bilateral lung apices.

No critical foraminal or canal stenosis in the cervical spine.

IMPRESSION:

Inflammatory change in the right floor of mouth and submandibular space with edema and fat stranding extending to the platysma and subcutaneous fat but no drainable fluid collection or abscess. Inflammation of the right submandibular gland, and right tonsillar pillar, likely secondary. Findings are suggestive of Ludwigs angina.

Attending note:

There is a low density region seen on series 2 image 50 anterior medial to the right submandibular gland. While this does not have peripheral enhancement and may represent a phlegmon along the anterior belly of the digastric muscle on the right side.