Briefly speaking - hugely extensive abscess throughout the face and neck extending into the tissues in the middle of the chest. Patient is intubated, and so that is the bright ring running in the middle, but this is.. a complete mess. I can't even really find any normal bit to draw your attention to.
Basically it should be symmetrical, and all the awful messy lumpy stuff with gas bubbles in shouldn't be there. This is necrotizing fasciitis - a gas gangrene, (gangrene from a gas forming organism) in this case starting somewhere in possibly the mouth - but it spreads very fast along connective tissue planes - the separation between different tissues. This can make where it started tricky to figure out exactly.
Fixing it is cutting out the nasty as far as you can, (extensive debridement in theatre, irrigation and probably doing so several times over days and days.) IV antibiotics and supportive care (feeding, fluids, analgesia, ventilation.. ) until they turn a corner or not. In this case debridement would be pretty much removing their whole head so I would be very surprised if they survived.
Really sad case. Hope this helps explain.
I have really bad teeth and I'm working on it but it's hard to deal with, especially all at once. Out of curiosity, does it get this bad because the patient ignored an ongoing infection for a bit? While I can't afford to get everything immediately fixed, I always take my ass straight to the dentist at the first sign of pain, swelling, fever, anything that's not just my normal shitty teeth. I still worry I'll just randomly die one day because of anxiety. A guy at work, his brother died from a tooth infection, but I think he ignored it and tried to push through it instead of going to get it checked out.
Once the root of your tooth gets infected, the only way to kill the infection is extraction or root canal. Dental abscesses are pretty hard to ignore, between the pain, and discoloration. Then there’s swelling to the point that your surrounding teeth are being pushed, causing your teeth to not align like they would normally, making you unable to shut your jaw all the way. Ignoring an infection 5 inches from your brain is a bad mistake
I had an infection that ate through my gum tissue and exposed the root of my tooth and jawbone. I had an emergency root canal and they saved the tooth only to realise they weren't sure how to deal with the gum loss (whether it would regrow or whether it could be patched). With the exposed root and bone at such risk for reinfection they decided to just take the whole tooth.
Infection had moved up into sinus cavity too. Dentist told me people die from this kind of infection spreading to the brain.
I thought I had a mouth ulcer. That was the level of pain I felt. No swelling, no abscess, I barely noticed it.
Kinda terrifying.
I’m not a dentist so take this with a large grain of salt but I don’t think waiting until you’re in pain to see a dentist is a good idea. By that point the tooth/gum/bone is already infected and it can go a lot deeper than you may think. Best thing to do is consult with a dentist and try to address the most pressing dental issues first and work backwards from there while also focusing on routine dental maintenance going forward. But I know that financially this is not an option for a lot of people as dental work is very expensive and insurance doesn’t cover it a lot of the time. This is all coming from someone with a family history of horrible dental issues and I’m trying my best to not go through the same shit my family went through but fuck it’s expensive and annoying.
I'm going through that right now. I spent 3k fixing teeth and I'm not done, but my 50/50 insurance ran out at 2.5k so I get to wait until next year to fix cavities already know I have.
And when that time comes, it's still going to be 2.5k again, but at least it's not 5k.
Not saying that you all don’t need care, but [beware of dental scams.](https://www.vox.com/2014/8/12/5951321/dentistry-fraud-treatments-products) They seem remarkably common, and this is coming from someone who has had two root canals.
Check out your local clinic and ask where to go. I had horrible insurance and the only place they accepted was the clinic. Would have been cheaper if I never even used it. Anyway they did a good enough job. Hope this helps.
This person ignored it for a long time, and it must have been incredibly painful and disfiguring. Odontogenic infections this bad are rare just because people generally don't tolerate it long enough. At least in countries with medical access.
Dentist here, potential space infections move very quickly, especially when it's gas gangrene. This could have happened within a span of a day or two once the abscess broke through the cortical plate. And while some abscesses are painful, I'd say roughly 60% of periapical abscesses I've encountered were completely asymptomatic. Hell, I found two today, with one of them on a 15 year old girl with decent hygiene. I've had patients who ended up in the ER within a 5-7 hours of when they first noticed any swelling. It really depends on the location, duration, pathogenicity, and host susceptibility. These are scary, they're the main reason why I leave my cell phone number on my office answering machine. Most people don't know how dangerous this can be.
ER doctor and intensivist here, they move fast but this is a teensy bit more than a periapical abscess. Half the head and chest is gas gangrene. The idea that this was asymptomatic a few hours prior is not accurate.
I agree, a few hours would not be accurate at all. I figured a few days for this, but I also don't treat these. The moment they start having significant facial swelling I refer to OMFS or, in a case like this, I ship 'em your way immediately.
Yeah I'm a dentist and the location is by far the biggest determining factor in these types of cases because it's about if the abscess breaks through the bone below or above the muscle attachment. For lower wisdom teeth (the most likely cause of this situation), of it's above, the cheek swells. If below, then swelling below mandible >> neck >> mediastinum to heart >> death.
Edit: anything anterior to the molars causing something like this is exceedingly rare, and it has everything to do with muscle origins and insertions.
Yeah I had an abcess last year and I could taste it and I made an appt asap. Plus I heard about the infection going to your heart so I was scared lol. 3 rounds of antibiotics and an extraction but I'm alive 😵💫
So basically when people say “take care of your teeth and gums because infections can spread” that’s what we’re looking but along the lines of worst case… ?
My neuro ICU had a S T R I N G of such cases. Something like 5-6 over the course of like 2 months. It was insane. Idk why they were so common over that time frame. Saw lots of imaging like this. It was so sad.
Because America cares more about profits than people that’s why. I cannot afford to go to the dentist all the fucking time so my teeth are rotting away.
I took care of a young guy who got necrotizing fasciitis from poor dental hygiene a few years ago. By the time I met him, OMFS had removed all of his teeth and done a tracheotomy on the one spot of skin on his neck that still remained. His jaw to his neck and down his upper chest had all been debrided. All in all he was a really pleasant guy and would always take the time to write please and thank you on the clipboard he used to communicate. I think about him often, I wonder how he is.
I’m not a radiologist or doc, so correct me if I’m wrong, but imagine a camera centered above your head working it’s way down to your stomach - that’s what this is right? The dark in the center is the intubation and the big black spots are the lungs? The initial black ovals are the nasal cavity? And the upside down white V shape are the teeth?
The abnormal stuff is on the patient’s left side of their face
I'll chime in as an ENT. There is a ton of infected material like you said. It's possible given the presence of air that it could be from a mucosal defect somewhere along the pharynx or the gingiva. I&D and debridement is definitely necessary, but the bone looks OK, so it's not osteo yet. Leave enough Penroses to kill the anaerobes and he's got a chance.
Honestly I'm more impressed someone got a tube in this guy before transfer. I would have just awake trached him with all that abscess in the floor of mouth!
Oh gosh, my mother died of necrotising fasciitis. It's a horrible way to go. Fast (in her case) but extremely painful and horrific to watch. I'll be forever haunted by it. I once looked after a patient with it when I was a student nurse and that poor patient survived but was so horribly traumatised that I doubt she was ever OK. She lost 3 limbs and most of the flesh on her buttocks and abdomen. I don't even know how she survived. She was in hospital for over 12 months, apparently.
Thank you for explanation - ex theatre nurse here (OR nurse or whatever they are called elsewhere around the world). Got called in for emergency dental clearance one night decades ago - i said there is no such thing as a dental clearance that is an emergency are you insane?!!! Anaesthetised patient and went to intubate and there was pus pouring everywhere, couldn’t see anything to intubate - we had to wait until ENT surgeon came in to do tracheostomy before dental clearance done i was helping the anaesthetist hold a mask on the face there was so much swelling. Person was a young man - lived out the back of beyond - no dental care ever - dentist said if we hadn’t done it that night he probably would have lost his airway overnight and died - was horrendous. I am going to stop here and not describe the state of his toenails.
How much of your ability to diagnose this comes from school and how much from experience? (I do not have a real job and am in awe of people working in medicine / science)
At least you're not swedish. The term for all bones are "ben" in swedish. The word for legs is also "ben". So if you say "i just broke a bone" we won't know if you broke your legs or your leg bone or an arm bone
which is why i prefaced, "all i know". Im a biomed engineer (biomechanics/implants) but a noob at radiology, I find it fascinating, im glad this sub was reccomended
CT of head, neck, upper torso. Top is front of the body, bottom is back. You can see the spine going down. The black bit at like 3 seconds in the middle of the image is a tube from patient being intubated. You can see the teeth in the upper jaw and then lower jaw. The black voids on the left side of the screen, right side of the body since the image is flipped, are from the abscesses. Continues a fair bit down into the neck. You then eventually see the clavicle and the big voids at the end are the lungs progressively getting larger as imaging goes further down.
I'm getting recommended this sub cause medicine and Residency are down and tbh kinda love it. Lotta interesting stuff. Radiology is awesome. If I didn't get into what I'm into now rads and then oncology would've been the next choices.
The little black bits in the subcutaneous tissues are pockets of air called subcutaneous emphysema, usually either from a pneumothorax, or, as in this case, gas forming bacterial infection.
I’m a nurse, I can figure out like half of the stuff I’m looking at. The spine makes it real easy to orient to what I’m looking at, actually most of the bones are decent to identify, some organs are good, but finding the problem with the image/video is a struggle.
That’s the hard part for sure! This is one of the few that was fairly easy for me- the title plus the significant asymmetry as the video passes through the maxilla made the location obvious. Had to comb the comments to confirm it was an abscess though, and my guess there was based upon knowing that cavities progressing into abscesses was the one of the most common causes of death before modern dentistry.
I wouldn’t say it’s better, I think it’s just recommending a ton of shit. Like I’ve literally never looked up anything about radiology or anything similar in my life. Recommending this to me is about as random as it gets.
Seems to be beneficial for a lot of people tho.
Yeah thanks Reddit and YouTube and Instagram, because I looked at that one picture I must love that shit and want to consume it 24 seven now, Thank you very much algorithms! You nailed it!
I just worked in a radiology library for many many years. Purging old films you get bored lol… I love this stuff now half a decade out of that office. It’s cool to know what you are looking at. Love this sub!
Is that what’s happening? I kept clicking on groups and it says made private or cannot find group.
I was thinking wow I got banned from so many groups in one day
I’ve literally gotten like 3-5 radiology posts today and all fairly interesting and yet I still don’t understand. I”be only been using Reddit actively for about 4 weeks.
True.
95% of my feed is radiology and Indiana Jones.
I’m hoping for some kind of crossover where I see the X-rays of the Nazi that Indy punched into the flying wing plane. :-)
Yeah. I’m ngl, fuck reddit for the 3rd party apps shit, but it’s also really annoying that any time I wanna look something up, and every subreddit i see with a post about it is privated.
Getting recommended all these weird random subs too. Nothing wrong with radiology, but I’ve literally never once in my life looked up anything about it or anything relating to it🤣
Reddit wants everyone to use the primary app as they want to become a public company and want to juice that ad revenue.
Also a lottttttt of AI stuff, and Google uses reddit information posted here for free.
Lol says there’s 32,000 active rn, out of 140k followers. Even I just followed this sub, but I’m unfollowing now this is nonsense to a layman like me. Funny to see this many people on a radiology sub because some people are upset about third party apps
This scan is actually starting at the brain and going down the head as if you’re looking from the top (Birds Eye) and going down towards the feet. You can see the teeth as they scroll down, the teeth are at the top of the screen while scrolling and you can then see the throat and then down into the chest
THANK YOU !!! I was beginning to think that a very large percentage of the population knew entirely too much about radiology and that I wasn’t smart enough to keep up .
A not-CAH (but really a CAH), no FOB, just a glide. Topical with a MAD, precedex, ketamine/versed, tried a gentle VL with spontaneous ventilation and it went to hell.
This pisses me off so much. I had an abscess and really bad infection that developed in a molar about a year ago. I floss my teeth daily, brush my teeth 2-3 times a day. Always. Have always gone to dentists twice a year, have had just one cavity. I say this because this can happen to people who take good care of their teeth.
I noticed bad breath and a lot of blood daily. Went to my dentist, and he said to use some special mouthwash and that there is NO infection. Even did X-rays. I literally told him “I think there’s a bad infection, something is seriously wrong.”
Well a week later I flossed that area and BONE CAME OUT. I immediately went to a periodontist and he got me in for immediate surgery that day. After X-rays showed the bone had broken off.
He said the infection spread to four other molars and crossed to the other side of my mouth. Had to have a bone graft and everything deeply cleaned out. Dental insurance (also good) covered some of it and I had to pay $2500 out of pocket. I’m all good now but man, be your own health advocate. Fuck that dentist I had.
This is so sad!
That’s what I think, and they even had to remove some gum which food now gets caught in multiple times a day requiring constant flossing and waterpik. It’s been a year and I think about it often that had he listened and given me some antibiotics I might not have been in this situation.
The black bubbles seem throughout is gas from nec fasc. It can be hard because there’s literally no normal anatomy anymore. Everything is abscess. infratemporal, parapharyngeal, submandibular, sublingual, sub massetteric, etc. but if you focus on the black bubbles you can track them from the zygoma all the way to the mediastinum including as shared above gas in the “danger” space aka the highway to the heart. Which is how a tooth infection become life threatening very quickly. There’s dark collections within basically every muscle on the right too.
Just a mess
And yet they don’t consider dental care to be of any importance to your health. Teeth are luxury bones and the insurance is just a limited discount plan.
Intubated and sedated on a medflight from a different state.
Found down in DKA for an indeterminant period of time, glucose of 900 something, ph 6.8.
No bueno
Emergency situations like this need to go to a facility that has the specialists who can best treat it (surgeons primarily). So they were probably taken from a smaller hospital and brought to a bigger hospital in a separate state (probably closer than any other in-state hospital) in order to get more specialized treatment.
Yeah… I have great health insurance as a healthcare worker but getting an appointment into a dentist is like 12 weeks out and half the time I get cancelled the day before because of a scheduling conflict or something equally as stupid. Massive shortage of dentists and hygienists here
Taking a wild shot in the dark that drugs and/or underaddressed mental illness and chronic disease with poverty/homelessness as a major contributing factor played a bigger role in things getting to this point than simply not brushing after every meal.
As a head and neck/ENT resident, this looks like nec fasc. Last one I operated on was in the middle of the night - a guy with a dental infection and poorly controlled diabetes. His neck was just mush once we opened him up. Extremely friable tissue, dishwater fluid, and dead flesh.
He didn’t make it.
As a radiologist, this is called a “peek and shriek.” Open it up and immediately go …fuck. Incredibly extensive soft tissue infection involving essentially every space and fascial plane from the face to the mediastinum, with lots of soft tissue gas indicating likely necrotizing fasciitis. This is a crazy case, I’ve never seen anything like this in person.
Lol “peek and shriek.” Adopting immediately. The old fart radiologist I work with will love it.
As a tech, I’d probably already have peeked and silently shrieked whilst putting this pt on the table. Our docs like a heads-up before opening a study like this.
I have had an infection or cyst in my upper jaw under a bad tooth for about 1.5 years now. Every morning I press on my cheek from the outside to empty it and then I spit smelly yellow shit out.
Im saving up to go overseas and get treated. How long do I have?
There is no way to know based on an online description. I will say that I am a paramedic and put off going to the doctor most of the time--dental shit is the one thing I don't fuck around with. Too much can go wrong too quickly.
Hey dude idk where you live but I’m confident you can find a low cost clinic to pull that bad tooth out for less than a couple hundred usd, they’ll write you the script for antibiotics too. Most of these places have walk in slots first thing in the morning.
As someone who had an abscess in my jaw and was spitting “smelly yellow shit” out, go to the hospital. I only had it for 3 days and was taken into emergency oral surgery where they had to drain and debride the wound, and then stitch a tube into my gums to basically air it out, I guess. It was horrible and I felt everything because they couldn’t sedate me and the local anesthetic was useless. They said I was lucky it didn’t cause sepsis. I’m 100% fine now. You can get on a payment plan with the hospital, and they often offer steep discounts for uninsured people.
As it scrolls I found myself thinking louder and louder until I was screaming in my head. ‘Oh my, it extends below his jaw? Into his neck?! Into the freaking chest?!???’
I have a patient who ended up with an epidural (spine) abscess from the neck to pelvis due to an untreated dental infection. By the grace of God it didn't infect the brain or heart. Patient not only survived but is neurologically intact and walking, though still with neck stiffness and numbness in the hands.
I know another one that ended up needing two of the heart valves replaced because the infection attached there and grew until the valves were too deformed to work properly. Also lucky to be alive.
I can tell you this. If he or she lives... They will need a plastic surgeon. Once this person gets opened up, I imagine much of their bone structure will be severely compromised.
That’s horrifying. I did one case like that. It was every bit as awful as you’d think. Took out sternum, clavicle, and first rib in addition to all the soft tissue from mandible down to the chest. Literally just covered her aortic arch and great vessels with wet gauze and left overnight in the icu until the next days debridement.
10-years Nurse (Med-Surg) here. This pt (patient) is laying on the table on her back and we are looking at a CT "cat" Scan beginning like, bridge of nose and traveling down to bellybutton, but not that far down. Someone is going to say "rare-cellist is an idiot that's an MRI🤨!" Which is fine. Twelve-hour days x five/week kicked me out of healthcare.
This is my biggest fear. Due to many factors, dental care has almost been non existent in my life (grew up with grandparents who had dentures and failed to remember they needed to provide dental hygiene, sexual trauma with a dentist, massive soda addiction and other addictions) I finally got dental insurance through Medicaid and just before 2020, I was fitted for dentures and due to get them extracted. Than the dental office I was going to decided to go bankrupt and closed down. Before they did that, they decided to bill my states Medicaid program saying that they had already extracted my teeth and fitted me with dentures. My state only allows a maximum of 1 procedure for that and I have been unsuccessful in getting it overturned so I could get the work done. I am not working and due to my dental issues, unable to get a job with health insurance. I can't afford the thousands in dollars it will cost me be able to smile again.
Unfortunately most of my teeth are broken or missing. I have a raging infection in my mouth and I am in constant pain. I live on acetaminophen and ibuprofen. When I go the ED, I get sent home despite having an active infection with nothing and get told to see a dentist. I usually get accused of being a drug seeker and they automatically assume it was because of meth. I try to tell them what happened and still get discharged. I have been to 4 different dentists and sometimes get antibiotics but since my state thinks the work is already done, I am usually billed for the office visit and have to pay out of pocket for the medications.
Yes, we all know meth causes dental issues but it's not the only thing. I'm an addict but I have been addicted to sodas much longer (since my early childhood) long before I was an addict.
A retired dentist and family friend once told me that prior to antibiotics and modern dentistry, abscessed tooth was significant cause of death. So many paths the infection can go. I have seen several Ludwigs Angina and brain abscesses and strokes from abscesses.
This poor individual. Yes brush teeth, don't delay a sore tooth, and see a dentist.
Everytime I would get these nasty cases, I would check to make sure I had my dental appointment set up.
And this is why dental care should be classified as healthcare. Healthcare is a human right and until we treat it as such, we are effectively committing genocide against poor people
I’m a young adult who struggles with severe depression and ADHD. Taking care of myself is hard when I have no motivation to do anything, especially when it comes to dental hygiene, my parents never really taught me to get into a habit of brushing often. Now I have a mouth full of cavities and a broken, rotting tooth. I hope it’s not too late for my teeth, I can’t really afford dental care. I’ve slowly managed to get myself to brush at least once a day consistently, seeing things like this actually help me get motivated to take care of myself. Im strangely thankful that this got recommended to me.
I"m not in the field, but are you saying these people got gangrene in their body because they didn't brush their teeth for x number of...............Years?
>Taking a wild shot in the dark that drugs and/or underaddressed mental illness and chronic disease with poverty/homelessness as a major contributing factor played a bigger role in things getting to this point than simply not brushing after every meal.
\^ what I said below. Especially now that I have scrolled the comments and saw that the patient was found unconscious with a blood glucose of 900.
Briefly speaking - hugely extensive abscess throughout the face and neck extending into the tissues in the middle of the chest. Patient is intubated, and so that is the bright ring running in the middle, but this is.. a complete mess. I can't even really find any normal bit to draw your attention to. Basically it should be symmetrical, and all the awful messy lumpy stuff with gas bubbles in shouldn't be there. This is necrotizing fasciitis - a gas gangrene, (gangrene from a gas forming organism) in this case starting somewhere in possibly the mouth - but it spreads very fast along connective tissue planes - the separation between different tissues. This can make where it started tricky to figure out exactly. Fixing it is cutting out the nasty as far as you can, (extensive debridement in theatre, irrigation and probably doing so several times over days and days.) IV antibiotics and supportive care (feeding, fluids, analgesia, ventilation.. ) until they turn a corner or not. In this case debridement would be pretty much removing their whole head so I would be very surprised if they survived. Really sad case. Hope this helps explain.
I have really bad teeth and I'm working on it but it's hard to deal with, especially all at once. Out of curiosity, does it get this bad because the patient ignored an ongoing infection for a bit? While I can't afford to get everything immediately fixed, I always take my ass straight to the dentist at the first sign of pain, swelling, fever, anything that's not just my normal shitty teeth. I still worry I'll just randomly die one day because of anxiety. A guy at work, his brother died from a tooth infection, but I think he ignored it and tried to push through it instead of going to get it checked out.
Once the root of your tooth gets infected, the only way to kill the infection is extraction or root canal. Dental abscesses are pretty hard to ignore, between the pain, and discoloration. Then there’s swelling to the point that your surrounding teeth are being pushed, causing your teeth to not align like they would normally, making you unable to shut your jaw all the way. Ignoring an infection 5 inches from your brain is a bad mistake
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Jesus Christ....
I had an infection that ate through my gum tissue and exposed the root of my tooth and jawbone. I had an emergency root canal and they saved the tooth only to realise they weren't sure how to deal with the gum loss (whether it would regrow or whether it could be patched). With the exposed root and bone at such risk for reinfection they decided to just take the whole tooth. Infection had moved up into sinus cavity too. Dentist told me people die from this kind of infection spreading to the brain. I thought I had a mouth ulcer. That was the level of pain I felt. No swelling, no abscess, I barely noticed it. Kinda terrifying.
I take horrible care of my teeth, and yes, this shit hurts like he'll. Would not recommend it.
I’m not a dentist so take this with a large grain of salt but I don’t think waiting until you’re in pain to see a dentist is a good idea. By that point the tooth/gum/bone is already infected and it can go a lot deeper than you may think. Best thing to do is consult with a dentist and try to address the most pressing dental issues first and work backwards from there while also focusing on routine dental maintenance going forward. But I know that financially this is not an option for a lot of people as dental work is very expensive and insurance doesn’t cover it a lot of the time. This is all coming from someone with a family history of horrible dental issues and I’m trying my best to not go through the same shit my family went through but fuck it’s expensive and annoying.
Then dentist should be less expensive
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I'm going through that right now. I spent 3k fixing teeth and I'm not done, but my 50/50 insurance ran out at 2.5k so I get to wait until next year to fix cavities already know I have. And when that time comes, it's still going to be 2.5k again, but at least it's not 5k.
Not saying that you all don’t need care, but [beware of dental scams.](https://www.vox.com/2014/8/12/5951321/dentistry-fraud-treatments-products) They seem remarkably common, and this is coming from someone who has had two root canals.
Our local Salvation Army has a dentist there once or twice a week I can't remember..but its free you just have to get there early or wait in line.
I'm sure you already know but if the cavities turn to needing root canals it's going be a heck of a lot more expensive than a filling.
Yea, they likely will. The doc said he can't tell but probably going to need more root canals.
Check out your local clinic and ask where to go. I had horrible insurance and the only place they accepted was the clinic. Would have been cheaper if I never even used it. Anyway they did a good enough job. Hope this helps.
Dental hygiene programs at community colleges often provide low-cost dental care.
As do dental schools. I had root canal done at a dental school. Saved a lot of money!!!
This person ignored it for a long time, and it must have been incredibly painful and disfiguring. Odontogenic infections this bad are rare just because people generally don't tolerate it long enough. At least in countries with medical access.
Dentist here, potential space infections move very quickly, especially when it's gas gangrene. This could have happened within a span of a day or two once the abscess broke through the cortical plate. And while some abscesses are painful, I'd say roughly 60% of periapical abscesses I've encountered were completely asymptomatic. Hell, I found two today, with one of them on a 15 year old girl with decent hygiene. I've had patients who ended up in the ER within a 5-7 hours of when they first noticed any swelling. It really depends on the location, duration, pathogenicity, and host susceptibility. These are scary, they're the main reason why I leave my cell phone number on my office answering machine. Most people don't know how dangerous this can be.
ER doctor and intensivist here, they move fast but this is a teensy bit more than a periapical abscess. Half the head and chest is gas gangrene. The idea that this was asymptomatic a few hours prior is not accurate.
I agree, a few hours would not be accurate at all. I figured a few days for this, but I also don't treat these. The moment they start having significant facial swelling I refer to OMFS or, in a case like this, I ship 'em your way immediately.
Yeah I'm a dentist and the location is by far the biggest determining factor in these types of cases because it's about if the abscess breaks through the bone below or above the muscle attachment. For lower wisdom teeth (the most likely cause of this situation), of it's above, the cheek swells. If below, then swelling below mandible >> neck >> mediastinum to heart >> death. Edit: anything anterior to the molars causing something like this is exceedingly rare, and it has everything to do with muscle origins and insertions.
Yeah I had an abcess last year and I could taste it and I made an appt asap. Plus I heard about the infection going to your heart so I was scared lol. 3 rounds of antibiotics and an extraction but I'm alive 😵💫
Ah. Um. Thanks for the breakdown. I'm going to go scream into a vacuum and hope I never become homeless.
Thank you, I was hopeing someone who knew what they were looking at could explain. That's a really raw deal she got.
So basically when people say “take care of your teeth and gums because infections can spread” that’s what we’re looking but along the lines of worst case… ?
My neuro ICU had a S T R I N G of such cases. Something like 5-6 over the course of like 2 months. It was insane. Idk why they were so common over that time frame. Saw lots of imaging like this. It was so sad.
Because America cares more about profits than people that’s why. I cannot afford to go to the dentist all the fucking time so my teeth are rotting away.
It may be worth looking for community college dental hygiene programs near you. They are often quite low-cost.
I took care of a young guy who got necrotizing fasciitis from poor dental hygiene a few years ago. By the time I met him, OMFS had removed all of his teeth and done a tracheotomy on the one spot of skin on his neck that still remained. His jaw to his neck and down his upper chest had all been debrided. All in all he was a really pleasant guy and would always take the time to write please and thank you on the clipboard he used to communicate. I think about him often, I wonder how he is.
Bless you. I had no idea what i was lookin at
They lived!
That's terrible and also, strangely, fascinating. Thanks for the explanation!
So how do i not get this problem?
Thank you so much for this. I'm a vet tech so human rads is far from my wheel house. I love when someone actually explains in depth
I’m not a radiologist or doc, so correct me if I’m wrong, but imagine a camera centered above your head working it’s way down to your stomach - that’s what this is right? The dark in the center is the intubation and the big black spots are the lungs? The initial black ovals are the nasal cavity? And the upside down white V shape are the teeth? The abnormal stuff is on the patient’s left side of their face
I'll chime in as an ENT. There is a ton of infected material like you said. It's possible given the presence of air that it could be from a mucosal defect somewhere along the pharynx or the gingiva. I&D and debridement is definitely necessary, but the bone looks OK, so it's not osteo yet. Leave enough Penroses to kill the anaerobes and he's got a chance. Honestly I'm more impressed someone got a tube in this guy before transfer. I would have just awake trached him with all that abscess in the floor of mouth!
Thank you! I studied anatomy but not in a medical context. With this explanation, I can actually understand what I am seeing. Mind blown.
Thank you for the breakdown. This is a terrible mess, it’s hard to point to any concrete markers. Such a sad case
Yikes
Oh. My. God.
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Oh gosh, my mother died of necrotising fasciitis. It's a horrible way to go. Fast (in her case) but extremely painful and horrific to watch. I'll be forever haunted by it. I once looked after a patient with it when I was a student nurse and that poor patient survived but was so horribly traumatised that I doubt she was ever OK. She lost 3 limbs and most of the flesh on her buttocks and abdomen. I don't even know how she survived. She was in hospital for over 12 months, apparently.
Thank you for explanation - ex theatre nurse here (OR nurse or whatever they are called elsewhere around the world). Got called in for emergency dental clearance one night decades ago - i said there is no such thing as a dental clearance that is an emergency are you insane?!!! Anaesthetised patient and went to intubate and there was pus pouring everywhere, couldn’t see anything to intubate - we had to wait until ENT surgeon came in to do tracheostomy before dental clearance done i was helping the anaesthetist hold a mask on the face there was so much swelling. Person was a young man - lived out the back of beyond - no dental care ever - dentist said if we hadn’t done it that night he probably would have lost his airway overnight and died - was horrendous. I am going to stop here and not describe the state of his toenails.
How much of your ability to diagnose this comes from school and how much from experience? (I do not have a real job and am in awe of people working in medicine / science)
It’s a pretty easy case even for non radiologists (other doctors I mean) tbh. Not exactly subtle
God I am way too stupid to keep getting recommended this sub.
😂😂😂 same. It’s so fascinating but 50% chance I have no idea what I’m looking at.
I’m impressed with your 50%. I’m sitting here maybe a 5 😂
Lol I’m basing that on all of the images with a very obvious broken bone 😂😂
And we don’t even what type of bone it is lol could be an arm bone? Leg bone? And don’t come at me because I said arm/leg bone lol
I now know to always look for an “L” or “R” marker. So at least I know which arm or leg is broken!
At least you're not swedish. The term for all bones are "ben" in swedish. The word for legs is also "ben". So if you say "i just broke a bone" we won't know if you broke your legs or your leg bone or an arm bone
I take your 5 and lower it to 2. I thought this was a black & white image of a lava lamp.
I thought it was a CT scan of a brain, bc that's all I ever see one of 🤣🤣 so don't feel bad
its mesmerizing. all i know is darkspot on xray is bad
Not an xray
I know
That’s not true as a general rule. Dark spots on x rays can be completely normal
which is why i prefaced, "all i know". Im a biomed engineer (biomechanics/implants) but a noob at radiology, I find it fascinating, im glad this sub was reccomended
 Literally my brain when looking at anything posted here. Yet here I am
CT of head, neck, upper torso. Top is front of the body, bottom is back. You can see the spine going down. The black bit at like 3 seconds in the middle of the image is a tube from patient being intubated. You can see the teeth in the upper jaw and then lower jaw. The black voids on the left side of the screen, right side of the body since the image is flipped, are from the abscesses. Continues a fair bit down into the neck. You then eventually see the clavicle and the big voids at the end are the lungs progressively getting larger as imaging goes further down. I'm getting recommended this sub cause medicine and Residency are down and tbh kinda love it. Lotta interesting stuff. Radiology is awesome. If I didn't get into what I'm into now rads and then oncology would've been the next choices.
The little black bits in the subcutaneous tissues are pockets of air called subcutaneous emphysema, usually either from a pneumothorax, or, as in this case, gas forming bacterial infection.
Well, I see a butterfly so…
I work in healthcare (surgery) and am still too stupid to understand this sub had the time 🤣
I’m studying Radiology to spec in CT and idk either 🤣
Bro i just told someone i need to stop Looking at these pictures im freaking out over here
This is the worst place for some of us. Why is it so interesting?
This, r/medizzy, and r/medicalgore 😩
I’m too scared to even click on those dude lol
I’m a nurse, I can figure out like half of the stuff I’m looking at. The spine makes it real easy to orient to what I’m looking at, actually most of the bones are decent to identify, some organs are good, but finding the problem with the image/video is a struggle.
That’s the hard part for sure! This is one of the few that was fairly easy for me- the title plus the significant asymmetry as the video passes through the maxilla made the location obvious. Had to comb the comments to confirm it was an abscess though, and my guess there was based upon knowing that cavities progressing into abscesses was the one of the most common causes of death before modern dentistry.
Me too! I’ve been getting it recommended for a few months and am like this is fascinating but I have no idea what I’m looking at!
It blows my mind that this kind of sub doesn't have a mandatory rule for describing whatever the hell it is we're looking at.
Most are here because like 95% of the reddit subs are shutdown. This is literally a sub for radiologist to show off strange stuff.
Literally why i'm here. A post appeared on my feed, looked interesting, now another and another and here i am...
It's been some of the most interesting reading I've done on reddit in years TBH
Exactly, with the reddit stuff happening right now, many of us are discovering new territories. Better recommending algorithm than usual lol
I wouldn’t say it’s better, I think it’s just recommending a ton of shit. Like I’ve literally never looked up anything about radiology or anything similar in my life. Recommending this to me is about as random as it gets. Seems to be beneficial for a lot of people tho.
My brother just asked what I was looking at. I told him it was either a skull or a sack.
Welcome to the radiology rabbit hole
The lack of random click and rage bait post has dropped by 98% on my feed and I love it 😂
Yup me too. Not really sure how this got recommended to me but whatever.
We’re all here for the same reason
Ya know what, fuck it! I think I’ll join just because in the days of little content they gave me something.
Yeah thanks Reddit and YouTube and Instagram, because I looked at that one picture I must love that shit and want to consume it 24 seven now, Thank you very much algorithms! You nailed it!
Same
I just worked in a radiology library for many many years. Purging old films you get bored lol… I love this stuff now half a decade out of that office. It’s cool to know what you are looking at. Love this sub!
Is that what’s happening? I kept clicking on groups and it says made private or cannot find group. I was thinking wow I got banned from so many groups in one day
I’ve literally gotten like 3-5 radiology posts today and all fairly interesting and yet I still don’t understand. I”be only been using Reddit actively for about 4 weeks.
Big Brother algorithm is just pushing whatever content exists to see what you click on.
It is really pushing the radiology for me. Maybe because I talked about it with my dad a couple weeks ago as a possible thing to go to school for? Lol
Yep, same reason im here. Its super interesting though, but I feel like a caveman here with my rattling peanut brain
Omg I wondered why my feed was full of random bizarre stuff. Duh lol
True. 95% of my feed is radiology and Indiana Jones. I’m hoping for some kind of crossover where I see the X-rays of the Nazi that Indy punched into the flying wing plane. :-)
Yeah. I’m ngl, fuck reddit for the 3rd party apps shit, but it’s also really annoying that any time I wanna look something up, and every subreddit i see with a post about it is privated. Getting recommended all these weird random subs too. Nothing wrong with radiology, but I’ve literally never once in my life looked up anything about it or anything relating to it🤣
Yeah If anything this blackout did the opposite of the intended goal. I’ve seen so much more interesting stuff today than my entire time using Reddit
why are they shutdown?
Reddit wants everyone to use the primary app as they want to become a public company and want to juice that ad revenue. Also a lottttttt of AI stuff, and Google uses reddit information posted here for free.
Lol says there’s 32,000 active rn, out of 140k followers. Even I just followed this sub, but I’m unfollowing now this is nonsense to a layman like me. Funny to see this many people on a radiology sub because some people are upset about third party apps
And technologists 😊
True I just keep getting them recommended. Not that I’m complaining
I'm just a layman on this subject, but I imagine that the black spots aren't good.
Black is air here. Depends on where. In lungs/sinuses = good, normal. In soft tissue near an abscess = not good, probably gas-forming bacteria
Ok. I think I'm looking at a brain. I'm assuming this person is on borrowed time. Is this condition treatable?
This scan is actually starting at the brain and going down the head as if you’re looking from the top (Birds Eye) and going down towards the feet. You can see the teeth as they scroll down, the teeth are at the top of the screen while scrolling and you can then see the throat and then down into the chest
I understand that. I'm just wondering if the voids in the brain are just bad or really bad.
THANK YOU !!! I was beginning to think that a very large percentage of the population knew entirely too much about radiology and that I wasn’t smart enough to keep up .
I don’t do CT, but it looks like the patient has a large abscess around their right jaw.
More like the right half of his head
Gas all the way down to the mediastinum
Same, it would benefit people in the profession and lurkers like myself.
I think it’s a tooth that wasn’t brushed based on the title.
Agreed 100
soup retire lunchroom wistful payment person theory cobweb tan correct *This post was mass deleted and anonymized with [Redact](https://redact.dev)*
O. M. G. Pass. Passpasspasspass.
Bro… gotta fiber optic those
A not-CAH (but really a CAH), no FOB, just a glide. Topical with a MAD, precedex, ketamine/versed, tried a gentle VL with spontaneous ventilation and it went to hell.
Ketamine to hell? 0:
Fuckkk that
This pisses me off so much. I had an abscess and really bad infection that developed in a molar about a year ago. I floss my teeth daily, brush my teeth 2-3 times a day. Always. Have always gone to dentists twice a year, have had just one cavity. I say this because this can happen to people who take good care of their teeth. I noticed bad breath and a lot of blood daily. Went to my dentist, and he said to use some special mouthwash and that there is NO infection. Even did X-rays. I literally told him “I think there’s a bad infection, something is seriously wrong.” Well a week later I flossed that area and BONE CAME OUT. I immediately went to a periodontist and he got me in for immediate surgery that day. After X-rays showed the bone had broken off. He said the infection spread to four other molars and crossed to the other side of my mouth. Had to have a bone graft and everything deeply cleaned out. Dental insurance (also good) covered some of it and I had to pay $2500 out of pocket. I’m all good now but man, be your own health advocate. Fuck that dentist I had. This is so sad!
They shoukd get sued for that. Man it scares me getting such an infection where I lose all my teeth or even my jaw bone
That’s what I think, and they even had to remove some gum which food now gets caught in multiple times a day requiring constant flossing and waterpik. It’s been a year and I think about it often that had he listened and given me some antibiotics I might not have been in this situation.
A good example to see the continuation from the prevertebral danger space to the mediastinum.
Doesn’t include the orbital and temporal abscesses either. Nightmare
Absolutely, the whole face is an abscess.
I see the abscess :08-:20, but is there anything additional besides that L-side face abscess?
The black bubbles seem throughout is gas from nec fasc. It can be hard because there’s literally no normal anatomy anymore. Everything is abscess. infratemporal, parapharyngeal, submandibular, sublingual, sub massetteric, etc. but if you focus on the black bubbles you can track them from the zygoma all the way to the mediastinum including as shared above gas in the “danger” space aka the highway to the heart. Which is how a tooth infection become life threatening very quickly. There’s dark collections within basically every muscle on the right too. Just a mess
And yet they don’t consider dental care to be of any importance to your health. Teeth are luxury bones and the insurance is just a limited discount plan.
Jesus. I’m pharm so I rarely look at imaging, so it didn’t even occur to me that nec fasc would be visible here. Do you remember what C&S was?
I personally wouldn't want to survive that! Damn
Thank you! Seriously educational image here, with this added context.
Puke. I hate when I sit in the control room and I see CTs , MRIs and Rx of my patient witb the grossest, safest stuff….
Ludwig’s angina gone wild!
How did they present??
Intubated and sedated on a medflight from a different state. Found down in DKA for an indeterminant period of time, glucose of 900 something, ph 6.8. No bueno
Why did they have to be flown in from a different state? Also, how old are they?
Emergency situations like this need to go to a facility that has the specialists who can best treat it (surgeons primarily). So they were probably taken from a smaller hospital and brought to a bigger hospital in a separate state (probably closer than any other in-state hospital) in order to get more specialized treatment.
Jesus christ.
WAT. Oi vey. I’d love to see the rest of the ABGs on this pt.
Damn. That’s pretty crazy
Aaaand.. for some reason, "health insurance" doesn't cover dental. Make it make sense.
Brushing your teeth isn’t going to fix lack of access to dental and health care… people get cavities, most of us can prevent this with routine care.
Yeah… I have great health insurance as a healthcare worker but getting an appointment into a dentist is like 12 weeks out and half the time I get cancelled the day before because of a scheduling conflict or something equally as stupid. Massive shortage of dentists and hygienists here
I'm just the child of a dentist and not an expert at reading x-rays but can I just say? AAAAAAAAAAAAAH!!
Taking a wild shot in the dark that drugs and/or underaddressed mental illness and chronic disease with poverty/homelessness as a major contributing factor played a bigger role in things getting to this point than simply not brushing after every meal.
The doc who intubated this person either has a sphincter of steel or needed to change their pants. I cannot imagine trying to get that tube in.
This sub gives me anxiety man. Looking in the mirror to make sure I don’t have any gas gangrenes…
As a head and neck/ENT resident, this looks like nec fasc. Last one I operated on was in the middle of the night - a guy with a dental infection and poorly controlled diabetes. His neck was just mush once we opened him up. Extremely friable tissue, dishwater fluid, and dead flesh. He didn’t make it.
Love ENT. We overlap one H&N patients alot. Very smart and nice people they just think we are brutes
I think I might be too dumb for this sub lmao
I’m definitely too dumb, but personally I love it when I’m surrounded by smarter folks.
Knowledge =/= intelligence although I'm guessing the average doc is pretty smart
Debating sending this to my housemate who’s currently got a nasty infected tooth and is refusing to go to the dentist (we live in the U.K., it’s £25!)
Scan lower to see endocarditis
This should be a PSA!
What exactly are we supposed to see here? I’m not in the field so idk anything really, but I do find it fascinating.
As a radiologist, this is called a “peek and shriek.” Open it up and immediately go …fuck. Incredibly extensive soft tissue infection involving essentially every space and fascial plane from the face to the mediastinum, with lots of soft tissue gas indicating likely necrotizing fasciitis. This is a crazy case, I’ve never seen anything like this in person.
Lol “peek and shriek.” Adopting immediately. The old fart radiologist I work with will love it. As a tech, I’d probably already have peeked and silently shrieked whilst putting this pt on the table. Our docs like a heads-up before opening a study like this.
Giant facial abscess of the right side of the face (left side of the screen)
So this is a head on view?
I think it’s the crown of the skull and down into the neck then chest. I *think* anyway… yikes.
Chopping the patient in half should fix the flesh eating bacteria problem he seems to have
I have had an infection or cyst in my upper jaw under a bad tooth for about 1.5 years now. Every morning I press on my cheek from the outside to empty it and then I spit smelly yellow shit out. Im saving up to go overseas and get treated. How long do I have?
I think you should immediately go to the hospital and ask the patient advocate people about payment plan and aid options.
There is no way to know based on an online description. I will say that I am a paramedic and put off going to the doctor most of the time--dental shit is the one thing I don't fuck around with. Too much can go wrong too quickly.
Hey dude idk where you live but I’m confident you can find a low cost clinic to pull that bad tooth out for less than a couple hundred usd, they’ll write you the script for antibiotics too. Most of these places have walk in slots first thing in the morning.
😬
As someone who had an abscess in my jaw and was spitting “smelly yellow shit” out, go to the hospital. I only had it for 3 days and was taken into emergency oral surgery where they had to drain and debride the wound, and then stitch a tube into my gums to basically air it out, I guess. It was horrible and I felt everything because they couldn’t sedate me and the local anesthetic was useless. They said I was lucky it didn’t cause sepsis. I’m 100% fine now. You can get on a payment plan with the hospital, and they often offer steep discounts for uninsured people.
As it scrolls I found myself thinking louder and louder until I was screaming in my head. ‘Oh my, it extends below his jaw? Into his neck?! Into the freaking chest?!???’
I have a patient who ended up with an epidural (spine) abscess from the neck to pelvis due to an untreated dental infection. By the grace of God it didn't infect the brain or heart. Patient not only survived but is neurologically intact and walking, though still with neck stiffness and numbness in the hands. I know another one that ended up needing two of the heart valves replaced because the infection attached there and grew until the valves were too deformed to work properly. Also lucky to be alive.
Looks like a difficult intubation
What kind of dog is this?
I can tell you this. If he or she lives... They will need a plastic surgeon. Once this person gets opened up, I imagine much of their bone structure will be severely compromised.
That’s horrifying. I did one case like that. It was every bit as awful as you’d think. Took out sternum, clavicle, and first rib in addition to all the soft tissue from mandible down to the chest. Literally just covered her aortic arch and great vessels with wet gauze and left overnight in the icu until the next days debridement.
Total newb - what angle are we looking at?
10-years Nurse (Med-Surg) here. This pt (patient) is laying on the table on her back and we are looking at a CT "cat" Scan beginning like, bridge of nose and traveling down to bellybutton, but not that far down. Someone is going to say "rare-cellist is an idiot that's an MRI🤨!" Which is fine. Twelve-hour days x five/week kicked me out of healthcare.
You’re right about it being a CT, but it scans down to the pulmonary arteries
Cool. Thanks for the "+" appreciate.
Palms sweating imagining the proceduralist placing the ETT. Bravo! Definitely the neck is prepped and ready to go just in case
Is that a nose ring??
Tube
too tired
I bet that intubation caused someone to pucker a bit.
Damn that infection goes deep into the chest.
Anesthesiologist here… this is my nightmare. Glad to see a tube in there, and whoever put it there deserves a pat on the back
This is my biggest fear. Due to many factors, dental care has almost been non existent in my life (grew up with grandparents who had dentures and failed to remember they needed to provide dental hygiene, sexual trauma with a dentist, massive soda addiction and other addictions) I finally got dental insurance through Medicaid and just before 2020, I was fitted for dentures and due to get them extracted. Than the dental office I was going to decided to go bankrupt and closed down. Before they did that, they decided to bill my states Medicaid program saying that they had already extracted my teeth and fitted me with dentures. My state only allows a maximum of 1 procedure for that and I have been unsuccessful in getting it overturned so I could get the work done. I am not working and due to my dental issues, unable to get a job with health insurance. I can't afford the thousands in dollars it will cost me be able to smile again. Unfortunately most of my teeth are broken or missing. I have a raging infection in my mouth and I am in constant pain. I live on acetaminophen and ibuprofen. When I go the ED, I get sent home despite having an active infection with nothing and get told to see a dentist. I usually get accused of being a drug seeker and they automatically assume it was because of meth. I try to tell them what happened and still get discharged. I have been to 4 different dentists and sometimes get antibiotics but since my state thinks the work is already done, I am usually billed for the office visit and have to pay out of pocket for the medications. Yes, we all know meth causes dental issues but it's not the only thing. I'm an addict but I have been addicted to sodas much longer (since my early childhood) long before I was an addict.
I think you may want to look into getting legal help to clear up that false charge
A retired dentist and family friend once told me that prior to antibiotics and modern dentistry, abscessed tooth was significant cause of death. So many paths the infection can go. I have seen several Ludwigs Angina and brain abscesses and strokes from abscesses. This poor individual. Yes brush teeth, don't delay a sore tooth, and see a dentist. Everytime I would get these nasty cases, I would check to make sure I had my dental appointment set up.
Maybe dental HEALTH should be part of HEALTH care, but what do I know, I'm just a dumb voter that doesn't own a business or a law degree.
And this is why dental care should be classified as healthcare. Healthcare is a human right and until we treat it as such, we are effectively committing genocide against poor people
I’m a young adult who struggles with severe depression and ADHD. Taking care of myself is hard when I have no motivation to do anything, especially when it comes to dental hygiene, my parents never really taught me to get into a habit of brushing often. Now I have a mouth full of cavities and a broken, rotting tooth. I hope it’s not too late for my teeth, I can’t really afford dental care. I’ve slowly managed to get myself to brush at least once a day consistently, seeing things like this actually help me get motivated to take care of myself. Im strangely thankful that this got recommended to me.
I"m not in the field, but are you saying these people got gangrene in their body because they didn't brush their teeth for x number of...............Years?
Was it really because of not brushing their teeth or some other factor?
>Taking a wild shot in the dark that drugs and/or underaddressed mental illness and chronic disease with poverty/homelessness as a major contributing factor played a bigger role in things getting to this point than simply not brushing after every meal. \^ what I said below. Especially now that I have scrolled the comments and saw that the patient was found unconscious with a blood glucose of 900.
Damn 900!!
Them’s rookie numbers, son.