A 25 year old male had submandibular swelling for last 7 days with mild fever. Incision and drainage procedure done with a drainage tube in situ and discharged with oral antibiotics. The patient suddenly felt respiratory distress on the same day after reaching home. He was immediately taken to Hospital and declared brought dead on arrival. On autopsy finger nail beds were cyanosed. On neck dissection pus was oozing and pus was present after reflecting the sternum. Pus was present around the two primary bronchi. What is the cause of death in this case ? Was it wise to discharge the patient on the same day ?

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Pus around bronchi leads to a probable cause of death of mediastinitis leading to endo/pericarditis or infective endocarditis...Submandibular abscess can lead to acute upper obstruction causing cynosis and hypoxia...also, it can go to the meninges causing meningitis and encephalitis..also, procedure related air embolism cannot be ruled out.. Incision and drainage generally does not require long admissions,however, given the location of the abscess ,one would've kept admitted for another day..

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This is a case of 304 A as doctors should not discharge this case as being operated . So also here no updates of pre intra and post operative data of this patient. Should refer this case to committee

By the time the patient reported he might have developed mediastinetes and pus in chest cavity.

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Ludwig angina

The diagnosis is probably Ludwig's angina. It was not proper to discharge the patient

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? Ludwig's Angina

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