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Ludwig’s Angina in a 4 Month Old Infant
IMAGES IN EMERGENCY MEDICINE Michal S. Maimon, MD, Arif S. Janjuh, MD, Ran D. Goldman, MD
From the Division of Pediatric Emergency Medicine, The Hospital for Sick Children (Maimon, Goldman), and the Department of Otolaryngology–Head and Neck Surgery, University of Toronto (Janjuh), Toronto, Ontario, Canada.
0196-0644/$-see front matter Copyright © 2006 by the American College of Emergency Physicians. doi:10.1016/j.annemergmed.2005.11.025
Figure 1. A symmetrical generalized submental fullness.
Figure 2. Swelling of the floor of the mouth. Used with permission of Michal S. Maimon, MD, Division of Pediatric Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
[Ann Emerg Med. 2006;47:503.] A 4-month-old girl presented to emergency department with fever of 40°C, irritability, and decrease in oral intake during the previous 24 hours. Ten hours before the girl’s presentation, her mother noticed swelling of her right submandibular area that rapidly progressed to the submental area. On physical examination, the child had a pulse rate of 178 beats/min, respiratory rate of 60 breaths/min, temperature of 38.7°C, and oxygen saturation of 98% in room air. The patient was stridorous while crying but had no respiratory distress at rest. A symmetric generalized fullness was noted in the submental area, with no erythema (Figure 1). Intraoral examination revealed a firm, tender swelling of the floor of the mouth, which was displacing the child’s tongue superiorly and posteriorly toward her palate and posterior pharyngeal wall (Figure 2).
Available online February 8, 2006. Volume , . : May
For the diagnosis and teaching points, see page 507. To view the entire collection of Images in Emergency Medicine, visit www.annemergmed.com Annals of Emergency Medicine 503
From the Division of Pediatric Emergency Medicine, The Hospital for Sick Children (Maimon, Goldman), and the Department of Otolaryngology–Head and Neck Surgery, University of Toronto (Janjuh), Toronto, Ontario, Canada.
0196-0644/$-see front matter Copyright © 2006 by the American College of Emergency Physicians. doi:10.1016/j.annemergmed.2005.11.025
Figure 1. A symmetrical generalized submental fullness.
Figure 2. Swelling of the floor of the mouth. Used with permission of Michal S. Maimon, MD, Division of Pediatric Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
[Ann Emerg Med. 2006;47:503.] A 4-month-old girl presented to emergency department with fever of 40°C, irritability, and decrease in oral intake during the previous 24 hours. Ten hours before the girl’s presentation, her mother noticed swelling of her right submandibular area that rapidly progressed to the submental area. On physical examination, the child had a pulse rate of 178 beats/min, respiratory rate of 60 breaths/min, temperature of 38.7°C, and oxygen saturation of 98% in room air. The patient was stridorous while crying but had no respiratory distress at rest. A symmetric generalized fullness was noted in the submental area, with no erythema (Figure 1). Intraoral examination revealed a firm, tender swelling of the floor of the mouth, which was displacing the child’s tongue superiorly and posteriorly toward her palate and posterior pharyngeal wall (Figure 2).
Available online February 8, 2006. Volume , . : May
For the diagnosis and teaching points, see page 507. To view the entire collection of Images in Emergency Medicine, visit www.annemergmed.com Annals of Emergency Medicine 503