Ludwig’s Angina

Ludwig’s angina denotes cellulitis of the floor of the mouth with infection of the submental, sublingual, and submandibular space. This infection is usually due to streptococcus or staphylococcus species. Patients usually present with pain, tenderness and swelling of the mouth floor. The infection is usually precipitated by an odontogenic infection. In neglected cases, Ludwig’s angina may spread inferiorly through fascial planes into the mediastinum, with some patients presenting with chest pain. Since the tongue can rapidly become posteriorly displaced in this condition, securing a patient’s airway is a priority.

Contrast-enhanced CT shows swelling of the floor of the mouth frequently associated with streaky changes in the adjacent subcutaneous fat and thickening of the overlying platysmus muscle. Enlargement of the submental or submandibular lymph nodes may also be seen, with pus or gas formation present in late cases.

Ludwig’s angina. Contrast enhanced CT shows multiple abscess (arrow) in the sublingual space.

Contrast enhanced MR images, if performed, may show a thickened floor of the mouth with strong enhancement. On T2-weighted images, diffuse high signals are evident in the floor of the mouth and adjacent soft tissues.