Presentation
Neck pain and fevers.
Patient Data
Extensive soft tissue gas with associated fluid and stranding in the floor of the mouth, anterior neck, slightly extending into the right base of the neck, and extensively throughout the upper and anterior mediastinum. Associated small pericardial effusion. Small bilateral pleural effusions with bibasilar atelectasis. A small amount of nonocclusive thrombus within the superior vena cava. Right mandibular molar caries with periapical lucencies.
Case Discussion
Typical imaging features of a life-threatening necrotizing soft tissue infection involving the floor of the mouth include an advanced presentation with extension into the anterior neck and mediastinum (necrotizing fasciitis). The floor-of-mouth imaging features are also known as Ludwig angina, presumably related to right periodontal disease.
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