This case is of a 76-year-old man who presented to the emergency department with a 24-h history of a progressive tense, tender midline neck swelling. A computed tomography scan revealed Ludwig’s angina and the patient went on to develop respiratory compromise and was admitted to the intensive care unit. The patient’s clinical course later became complicated by abscess formation requiring drainage under general anaesthetic. He was eventually discharged home some 9 days after his initial presentation. The emergency medicine management issues surrounding Ludwig’s angina are discussed briefly. This case highlights the dynamic airway changes seen in this uncommon condition. Whereas Ludwig’s angina has previously been associated in the emergency medicine literature with a younger age group and in patients with a history of dental infection or treatment, this case highlights the fact that it may occur despite these two common associations.
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