Case Report

Ludwig’s Angina: An Uncommon Cause of Chest Pain

Authors: María Elena Ocasio-Tascón, MD, Miriam Martínez, MD, Arturo Cedeño, MD, Alfonso Torres-Palacios, MD, Edwin Alicea, MD, William Rodríguez-Cintrón, MD

Abstract

A 71-year-old male with coronary artery disease, hypertension, diabetes mellitus, tobacco and opioid dependence came to the emergency room complaining of one episode of retrosternal chest pain oppressive in nature of one day of evolution. He had acute respiratory distress and required mechanical ventilation. The initial impression was myocardial ischemia, but electrocardiography and cardiac enzymes ruled it out. During the following hours, neck and tongue edema developed. He was started on broad-spectrum antibiotics empirically. Neck computed tomography scan revealed a left parapharyngeal and submandibular abscess. The abscess was drained. The source of infection was found on the second molar of the left lower jaw. The patient improved and was successfully weaned from mechanical ventilation. Despite advances in therapy, Ludwig’s angina remains a potentially lethal infection in which early recognition plays a crucial role.


Key Points


* Dental infections are common among the general population.


* Their usual course is benign but sometimes can lead to life-threatening complications such as Ludwig’s angina.


* Early, aggressive therapy is essential for a successful outcome.

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References

1. Nguyen V, Potter J, Hersh-Schick M. Ludwig’s angina: an uncommon and potentially lethal neck infection. AJNR Am J Neuroradiol 1992;12:215–219.
 
2. Moreland LW, Corey J, McKenzie R. Ludwig’s angina: report of a case and review of the literature.Arch Intern Med 1988;148:461–466.
 
3. Fritsch DE, Klein DG. Curriculum in critical care: Ludwig’s angina. Heart Lung 1992;21:39–47.
 
4. Ferrera P, Busino L, Snyder H. Uncommon complications of odontogenic infections. Am J Emerg Med 1996;14:317–322.
 
5. Finch R, Snider G, Sprinkle P. Ludwig’s angina: medical emergency medicine. JAMA1980;243:1171–1173.
 
6. Schafer T, Adair S. Prevention of dental disease: the role of the pediatrician. Pediatr Clin North Am2000;47:1021–1042.
 
7. Weisenengreen H. Ludwig’s angina: historical review and reflections. Ear Nose Throat J1986;56:457–461.
 
8. Muckelston HS. Angina Ludovici and kindred infections: a historical and clinical study. Ann Otol Rhinol Laryngol 1928;37:711–735.
 
9. Williams AC. Ludwig’s angina. Surg Gynecol Obstet 1940;70:140–149.
 
10. Williams AC, Guralnick WC. The diagnosis and treatment of Ludwig’s angina: a report of twenty cases. N Engl J Med 1943;228:445–450.
 
11. Flynn T. The swollen face: severe odontogenic infections. Emerg Med Clin North Am 2000;18:481–519.