Abstract
Ludwig's angina is a rare, life-threatening cellulitis of the submandibular space, if unchecked, can rapidly progress to severe complications such as necrotizing mediastinitis, a condition with significant morbidity and mortality. We report the case of a 32-year-old male who developed this rare complication following wisdom tooth extraction. The patient presented with throat swelling and hematemesis, and contrast-enhanced computed tomography (CT) imaging had a decisive role in capturing the full extent of the infection, revealing severe airway narrowing, mediastinal free air, and a suspected superior vena cava thrombus. These imaging findings shaped critical clinical decisions, leading to urgent surgical drainage performed jointly by thoracic and ear, nose and throat teams along with aggressive therapy. CT not only guided treatment but also provided a roadmap for tracking disease resolution and detecting complications. Despite severe systemic involvement, including sepsis and hypotension, the patient responded well to a targeted antimicrobial regimen and supportive care. This case highlights the importance of multidisplinary work in such extensive cases, and emphasizes how radiology is more than a diagnostic tool and is an active force in shaping the management and outcome of complex infections, allowing for precise intervention before irreversible complications arise. LEARNING POINTS: Ludwig's angina can rapidly progress to necrotizing mediastinitis, even after a routine dental procedure, making early recognition and timely intervention critical.Computed tomography is essential in assessing the extent of infection, identifying airway compromise and mediastinal involvement, which directly influence management decisions.A multidisciplinary approach, including early surgical intervention and aggressive antibiotic therapy, is crucial for optimizing outcomes in complex infections like necrotizing mediastinitis.