Superior vena cava syndrome vs ludwig’s angina: A diagnostic dilemma

Abstract

Introduction: We present an interesting diagnostic dilemma between superior vena cava syndrome and Ludwig Angina to highlight ways to differentiate between these two seemingly similar conditions. Presentation of case: A 50-year-old man presented with complaints of progressive breathing difficulty with diffuse brawny swelling in the neck and clinically gave impression of Ludwig angina, however, on further evaluation was diagnosed with superior vena cava syndrome (SVCS) secondary to non small cell carcinoma of lung. Discussion: This paper illustrates an interesting scenario in which clinical presentation of SVCS mimicked Ludwig’s Angina. SVCS with a gradual onset may have minimal symptoms with facial edema, erythema and venous distension in the chest and neck. Occasionally atypical presentation of Ludwig’s angina may mimic SVCS where high degree of clinical suspicion is needed to discriminate them. Conclusion: Superior vena cava syndrome may present with symptoms suggestive of Ludwig’s angina, especially if the obstruction is slowly progressive. A high index of suspicion is necessary in these cases.