Monthly Archives: November 2013

Superior Vena Cava Syndrome

SVCS – Caused by Obstruction

  • Caused by direct obstruction of the superior vena cava
  • Usually by malignancies of lung tumors, thymomas or mediastinal lymphadenopathies.
  • Most common is Bronchiogenic carcinoma

Signs and Symptoms of Superior Vena Cava Syndrome

  • Facial Edema
  • Venous distention in the neck
  • Arm edema
  • Cough
  • Bluish tint, not to be confused with Tyndall effect from Hyaluronic Dermal Filler injections
  • development of facial flushing, distended neck veins when raising arms above head.


Ludwig’s Angina – a serious infection of the floor of the mouth

Ludwig’s Angina – a cellulitis of the face and mouth

  • usually occurring in adults
  • May obstruct airways
  • Might need a tracheotomy
  • Can require surgical management and ICU

Ludwig’s Angina is also called:

  • Angina Ludovici
  • Cellulitis of the floor of the mouth
  • Angina Maligna
  • Morbus Strangularis

History of the name Ludwig’s Angina

Named after Wilhelm Friedrich von Ludwig who is a German physician who first described this condition in 1836.  He died in 1865 of a unspecified neck infection.

Causes of Ludwig’s Angina

  • Dental infections
  • Infection of the gums
  • Immunocompromised patients
  • Tongue piercing
  • Infections from other procedures on the face.  Side note, see my other webpage:  Botox and Juvederm injections in Modesto – sterile technique is important.  Note: Botox and Dermal Fillers have not had any reports of association with Ludwig’s Angina.  But infection prevention and knowledge is always on my mind.

Symptoms and signs of Ludwig’s Angina

  • Cellulitic facial infection (side note: facial peels in Modesto, CA)
  • Bilateral lower facial swelling around the lower jaw and upper neck.
  • Spread to involve submandibular, sublingual, and submental spaces of the face.
  • Difficulty swallowing
  • There may be stridor or difficulty breathing.
  • Can extend into the anterior mediastinum – with some patients presenting with chest pain.
  • diverse in presentation ranging from enlargement of lymph nodes to necrotizing fasciitis.
  • Tongue can be posteriorly displaced – airway concerns.

Radiographic appearance of Ludwig’s Angina

ludwig angina from world journal of radiology

arrow shows multiple abscess in the sublingual space

Treatment of Ludwig’s Angina

  • Getting prescription antibiotic medications
  • Monitoring and protecting the airway
  • Urgent facial surgery or dental consultation to incise and drain infection collections.
  • Fatality rate is about 5%