gms | German Medical Science

A 17-year-old Egyptian male developed Ludwig’s angina after a failed trial of treatment a left lower teeth abscess, which was complicated by LT sided empyema and pneumonia.

Assessment/Results: The patient arrived at ER dep. .Intraoral examination showed moderate trismus, fetid odor. There was bilateral sublingual edema (left > right) and an ulceration in the left floor of the mouth that was spontaneously draining purulent fluid. No cardiac murmurs or rubs were evident.

Initial diagnostic laboratory testing showed a white blood cell count (WBC) of 34,400/mm³.Airway films was normal .The computed tomography (CT) scans of neck obtained on admission suggested edema of the submandibular and submental regions. Concurrent diagnoses of Ludwig’s angina, was made and underwent external incision and l drainage of the neck swelling by transverse incision. Drains were placed. Pus samples were sent for culture and antibiotic sensitivity testing folowed by admision on empirical i.v. antibiotics until culture revealed the organism that was pseudomonas sensitive for TIENAM , after one week of teatment , the neck swelling subsides, pt developed chest pain and dysnea, chest x-ray film was done and revealed LT sided massive opacity involving the whole left hemithorax and thoracocentesis was done in the emergency room by cardiothoracic resident which yielded pus that sent for microscopic examination and culture and sensitivity so it was diagnosed empyema that needs urgent chest tube insertion that revealed 600 c.c of pus and left in the patient for 7 day with daily follow up by chest x/ray till whole chest is clear and the drain removed, the patient was discharged on day 16.

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