Imaging

Ludwig's Angina

Preliminary Diagnosis: Ludwig's Angina

I. What imaging technique is first-line for this diagnosis?

Contrasted CT of the soft tissues of the neck

II. Describe the advantages and disadvantages of this technique for diagnosis of Ludwig's angina.

Advantages

  • Highly sensitive and specific imaging modality in characterizing and diagnosing Ludwig's angina

  • Highly adept in characterizing the primary abnormality (cellulitis of the floor of the mouth) and any secondary complications

  • May help guide any percutaneous interventions (i.e., biopsy and/or abscess drainage)

  • Highly adept in characterizing any associated dental infections

Disadvantages

  • Exposes patients to ionizing radiation

III. What are the contraindications for the first-line imaging technique?

  • May be contraindicated in pregnant patients

IV. What alternative imaging techniques are available?

  • Contrasted MR of the soft tissues of the neck

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of Ludwig's angina.

Contrasted MR of the soft tissues of the neck

Advantages

  • Offers exquisite visualization of the surrounding soft tissues

  • Highly adept in characterizing any secondary complications, abscess development

  • Does not expose patients to ionizing radiation

Disadvantages

  • Expensive

  • May be subject to motion and susceptibility weighted artifact degrading image quality

  • Less sensitive and specific in evaluating the surrounding osseous structures (i.e., dental infections) than other imaging modalities

VI. What are the contraindications for the alternative imaging techniques?

Contrasted MR of the soft tissues of the neck

  • Patients with non-MR compatible hardware

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