From the Guidelines
Ludwig's angina is diagnosed through a combination of clinical examination, laboratory tests, and imaging studies, with a focus on identifying rapidly progressive bilateral submandibular swelling, systemic infection signs, and airway compromise. The diagnostic criteria for Ludwig's angina involve recognizing the characteristic symptoms, including rapidly progressive bilateral submandibular swelling, floor of mouth elevation, tongue displacement, dysphagia, drooling, and potential respiratory distress 1.
Clinical Examination
Physical examination should focus on identifying firm, tender swelling in the submandibular and sublingual spaces, along with signs of systemic infection such as fever and tachycardia. Dental examination is crucial as most cases originate from infected lower molars.
Laboratory Tests and Imaging
Laboratory tests, including complete blood count showing leukocytosis and elevated inflammatory markers, support the diagnosis. Imaging is essential, with contrast-enhanced CT being the gold standard to visualize the extent of infection, identify potential abscesses, and assess airway compromise, as discussed in the context of soft tissue infections of the head and neck 1. MRI may provide additional soft tissue detail in complex cases. Blood cultures should be obtained before starting antibiotics, though they may be negative if the patient has already received antimicrobials.
Importance of Early Diagnosis
Early diagnosis is critical as Ludwig's angina can rapidly progress to airway obstruction, requiring immediate intervention. The condition must be differentiated from other neck infections such as peritonsillar abscess, parapharyngeal abscess, or submandibular sialadenitis, which may present with similar but more localized symptoms. Accurate etiologic diagnosis depends on the collection of an aspirate or biopsy of inflammatory material from affected tissues and tissue spaces, as outlined in guidelines for the diagnosis of infectious diseases 1.
From the Research
Diagnostic Criteria for Ludwig's Angina
The diagnostic criteria for Ludwig's angina include:
- Clinical suspicion based on symptoms such as cervical pain, dyspnea, dysphagia, symmetrical neck swelling, and fever 2
- Physical examination findings, including a sore throat, progressively worsening shortness of breath, and submandibular swelling accompanied by self-reported fever, chills, and night sweats 3
- Imaging studies, such as CT and ultrasound (US), to confirm the diagnosis and determine the extent of the infection 3, 2, 4
- Microbiological examination to identify the causative microorganisms 2, 5
Key Symptoms and Signs
Key symptoms and signs of Ludwig's angina include:
- Rapidly progressive cellulitis-causing airway obstruction 3
- Brawny induration of the floor and suprahyoid region (bilaterally) 5
- Elevation of the tongue potentially obstructing the airway 5
- Bilateral submandibular swelling 2, 5
- Fever, neck swelling, and dyspnea 2, 5
Importance of Early Diagnosis and Treatment
Early diagnosis and treatment are essential for preventing potentially fatal complications of Ludwig's angina, including respiratory collapses, mediastinitis, pleural empyema, pericarditis, and pericardial tamponade 2, 6