Sir, a 26-year-old previously fit and healthy male presented with a dental infection, causing acute sepsis, upper airway compromise, and gross neck swelling. This was diagnosed as Ludwig's Angina. He was treated with surgical drainage but required aggressive inotropic support. Chest x-ray (Fig. 1) showed a widened mediastinum and CT confirmed a large mediastinal collection and pericarditis. A pig-tail catheter was inserted under radiographic guidance and drained 750 ml of pus overall. The patient made an uneventful recovery following this. Mediastinal collection is an unusual sequel to orofacial infections with a 70% mortality and should be excluded in non-resolving cases.

Figure 1
figure 1

X-ray showing a widened mediastinum

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