1. PATIENT PRESENTATION
A healthy 8‐year‐old male presented to the emergency department with neck swelling and fever for 6 days. Two days before, he was seen at urgent care with a negative rapid group A strep test and diagnosed with viral pharyngitis. Physical examination revealed a well‐appearing boy with noted submental swelling with dysphagia and trismus (Figures 1 and 2).
FIGURE 1.
Patient's chin, frontal view.
FIGURE 2.
Patient's chin, profile view.
2. DIAGNOSIS
2.1. Pediatric Ludwig's Angina
A point‐of‐care ultrasound and subsequent computed tomography (CT) imaging confirmed a 1.5 × 1.8 × 1.4 cm sublingual abscess with submental cellulitis (Figures 3 and 4). The patient was started on intravenous antibiotics, endotracheally intubated, and taken to the operating room for incision and drainage. His postoperative course was uncomplicated, and the patient had no recurrence on outpatient follow‐up.
FIGURE 3.
Submental ultrasound with transverse view demonstrating a heterogenous anechoic fluid collection (arrow).
FIGURE 4.
Computed tomography with a sagittal view and intravenous contrast demonstrating a submental fluid collection (arrow) and surrounding soft tissue swelling.
Ludwig's angina is the swelling of the submandibular space by soft tissue swelling or fluid collection. Ludwig's angina in pediatric patients is uncommon, occurring in 1 in 4 cases of Ludwig's. 1 , 2 Odontogenic infections account for the majority of Ludwig's angina as infections of the second and third premolar propagate into the submandibular space; however, systemic spread can also occur. 3 Ultrasound can be an initial imaging technique, but CT can confirm the diagnosis and determine any odontogenic nidus. Ludwig's angina is an airway emergency as localized swelling in the submandibular space can occlude the airway. Thus, management consists of early recognition, airway management, antibiotics, and surgical drainage. Antibiotics should be tailored to cover anaerobic organisms and mouth flora, and surgical incision and drainage may be warranted to relieve fluid collection. 4
Koo A, Fichadia U. Child with submental swelling. JACEP Open. 2022;3:e12836. 10.1002/emp2.12836
Contributor Information
Alex Koo, Email: alex.y.koo@medstar.net.
Utkarsh Fichadia, Email: utkfichadia@gmail.com.
REFERENCES
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