A Case of Ludwig’s Angina: Life Threatening Deep Neck Infection Presenting with Unusual Symptoms of Chest Pain.

Ludwig’s angina is a potentially lethal deep neck infection associated with rapid airway obstruction due to swelling of the neck, tongue and submandibular areas. Despite the name, it has no relation to angina pectoris. We report a case of an 80-year-old gentleman who presented with the unusual symptom of chest pain and previous history of diabetes mellitus and treated lymphoma, who was later diagnosed with Ludwig’s angina. Despite of early intravenous antibiotics, airway support and intensive care treatment patient died within 24 hours. This case highlights the need for a high index of suspicion for Ludwig’s angina in patients with chest pain and neck swelling, as although it’s lethal condition but early, rapid and aggressive intervention can save lives.

Vasodepressor Syncope and Recurrent Carcinoma of Pharynx: A Sign of Malignant Recurrence.

We present the case of a 66-year-old man under surveillance for oropharyngeal malignancy. The presentation was that of recent onset recurrent syncopal attacks associated with neck pain. Both bradycardia and hypotension were seen during the syncopal events. Although recurrence of malignancy had not been proven at the time of presentation, this was subsequently confirmed. In this case syncope was successfully managed with Midodrine, and permanent pacemaker implantation was avoided. A review of the literature identified similar cases, where the presumptive mechanism for syncope is mediated via the glossopharyngeal nerve. Such cases follow a similar clinical course, with an unpredictable response to standard therapies, including pacemaker implantation. Clinicians should be aware that syncope associated with head and neck cancer may herald recurrence of malignancy.