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Diagnose on Sight: Case of a red, swollen neck

2016-12-22T19:19:10+00:00

Ludwig's AnginaCase: A 78 year-old female with a past medical history of asthma and hypothyroidism presents with a three day history of sore throat and a two day history of a “lump” along the right side of her neck. The “lump” has now progressed to involve both sides of her anterior neck and is accompanied with erythema, tenderness to palpation, and swelling. In addition, the patient has developed a hoarse voice and odynophagia. The patient’s primary care physician referred her to an ENT specialist, who then referred the patient to the ED for urgent imaging due to the concern for a deep space neck infection. Triage vitals are remarkable for a heart rate of 118 beats per minute. She is otherwise normotensive and afebrile. On physical exam, slight crepitation in noted on the floor of the patient’s mouth. Of note, the patient also informs you of her penicillin allergy. Which of the following is the biggest risk factor for this particular disease process? 

Poll Results

Answer

Master Clinician Bedside Pearls

Edward Klofas, MD 
Clinical Associate Professor of Emergency Medicine
Stanford University

1.
Candamourty R, Venkatachalam S, Babu M, Kumar G. Ludwig’s Angina – An emergency: A case report with literature review. J Nat Sci Biol Med. 2012;3(2):206-208. [PubMed]
2.
Barakate M, Jensen M, Hemli J, Graham A. Ludwig’s angina: report of a case and review of management issues. Ann Otol Rhinol Laryngol. 2001;110(5 Pt 1):453-456. [PubMed]
3.
Srirompotong S, Art-Smart T. Ludwig’s angina: a clinical review. Eur Arch Otorhinolaryngol. 2003;260(7):401-403. [PubMed]
4.
Boscolo-Rizzo P, Da M. Submandibular space infection: a potentially lethal infection. Int J Infect Dis. 2009;13(3):327-333. [PubMed]
Shyam Sivasankar, MD

Shyam Sivasankar, MD

PGY3 Emergency Medicine Resident
Stanford University - Kaiser
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Shyam Sivasankar, MD

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Daniel Migliaccio, MD

Daniel Migliaccio, MD

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