Importance of the Physical Exam in Diagnosing Ludwig’s Angina Without Access to Modern Imaging Modalities in the Developing World

Ludwig's angina (LA) is a rapidly progressive cellulitis-causing airway obstruction that can spread through fascial planes to the floor of the mouth and into the mediastinum. Early recognition and treatment are essential for preventing potentially fatal complications. Diagnosis is based on clinical suspicion and confirmed through CT and ultrasound (US). In areas lacking access to imaging modalities, clinicians must rely on a thorough physical examination. Reporting this case is to raise awareness for LA in underserved areas with a higher risk for infection. The case describes a 54-year-old female with a two-day history of an untreated throat infection that likely developed LA. She presented with a sore throat, progressively worsening shortness of breath, and submandibular swelling accompanied by self-reported fever, chills, and night sweats. With the limited resources available at the rural clinic, she was treated with oral metronidazole, amoxicillin, as well as prednisone. She was referred to the nearest hospital for an immediate surgical consultation.