Periapical inflammatory lesion

Case contributed by Bruno Di Muzio
Diagnosis almost certain

Presentation

Presented to emergency department complaining of dental pain (right inferior molar teeth region).

Patient Data

Age: 25 years
Gender: Male

Panoramic radiograph (OPG)

x-ray

There is a thin rim of lucency surrounding the root of the right inferior first molar tooth with associated faint bone ground glass opacities inferring surrounding osteitis. Given the clinical picture, the features are concerning for early periapical abscess and further dentist review is recommended. 

Case Discussion

Although not a common routine in most radiology departments, panoramic radiographs done for dental conditions eventually pop up on your work list. 

This case has subtle changes that are better appreciated when correlated with the clinical information. The imaging features are those of early inflammatory changes at the root of a molar tooth, likely an early periapical abscess, also referred as acute apical periodontitis or periapical inflammatory lesion. 

The patient was referred for dentist review.  

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