From Routine to Ruin: An Astonishing Computed Tomography Scan Reveals Catastrophic Ludwig's Angina and Necrotizing Mediastinitis after a Simple Dental Procedure.

Q3 Medicine
European journal of case reports in internal medicine Pub Date : 2025-04-03 eCollection Date: 2025-01-01 DOI:10.12890/2025_005285
Amer Abu-Shanab, Anoohya Vangala, Zain Albdour, Hamzeh Nasr, Malay Rathod, Doangton Du
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引用次数: 0

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.

Learning points: Ludwig's angina can rapidly progress to necrotizing mediastinitis, even after a routine dental procedure, making early recognition and timely intervention critical.Computed tomography is essential in assessing the extent of infection, identifying airway compromise and mediastinal involvement, which directly influence management decisions.A multidisciplinary approach, including early surgical intervention and aggressive antibiotic therapy, is crucial for optimizing outcomes in complex infections like necrotizing mediastinitis.

从常规到毁灭:一个惊人的计算机断层扫描显示灾难性的路德维希心心炎和坏死性纵隔炎在一个简单的牙科手术后。
路德维希氏心绞痛是一种罕见的、危及生命的下颌间隙蜂窝织炎,如果不加以控制,可以迅速发展为严重的并发症,如坏死性纵隔炎,这是一种发病率和死亡率都很高的疾病。我们报告一个32岁的男性病例,他在拔除智齿后出现了这种罕见的并发症。患者表现为喉咙肿胀和吐血,CT增强成像在捕捉感染的全部程度方面起决定性作用,显示严重气道狭窄,纵隔游离空气,疑似上腔静脉血栓。这些影像学发现形成了关键的临床决策,导致胸、耳、鼻、喉团队联合进行紧急手术引流,同时进行积极的治疗。CT不仅指导治疗,而且为跟踪疾病的解决和发现并发症提供了路线图。尽管严重的全身受累,包括败血症和低血压,患者对靶向抗菌方案和支持性护理反应良好。该病例强调了在如此广泛的病例中多学科工作的重要性,并强调放射学如何不仅仅是一种诊断工具,而且是形成复杂感染的管理和结果的积极力量,允许在不可逆转的并发症出现之前进行精确干预。学习要点:即使在常规牙科手术后,路德维希心衰也可以迅速发展为坏死性纵隔炎,因此早期识别和及时干预至关重要。计算机断层扫描在评估感染程度、识别气道损害和纵隔受累方面是必不可少的,这直接影响到管理决策。多学科的方法,包括早期手术干预和积极的抗生素治疗,对于优化像坏死性纵隔炎这样的复杂感染的结果至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.10
自引率
0.00%
发文量
166
审稿时长
8 weeks
期刊介绍: The European Journal of Case Reports in Internal Medicine is an official journal of the European Federation of Internal Medicine (EFIM), representing 35 national societies from 33 European countries. The Journal''s mission is to promote the best medical practice and innovation in the field of acute and general medicine. It also provides a forum for internal medicine doctors where they can share new approaches with the aim of improving diagnostic and clinical skills in this field. EJCRIM welcomes high-quality case reports describing unusual or complex cases that an internist may encounter in everyday practice. The cases should either demonstrate the appropriateness of a diagnostic/therapeutic approach, describe a new procedure or maneuver, or show unusual manifestations of a disease or unexpected reactions. The Journal only accepts and publishes those case reports whose learning points provide new insight and/or contribute to advancing medical knowledge both in terms of diagnostics and therapeutic approaches. Case reports of medical errors, therefore, are also welcome as long as they provide innovative measures on how to prevent them in the current practice (Instructive Errors). The Journal may also consider brief and reasoned reports on issues relevant to the practice of Internal Medicine, as well as Abstracts submitted to the scientific meetings of acknowledged medical societies.
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