Descending Necrotizing Anterior Mediastinitis: Analysis of Survival and Surgical Treatment Modalities

Misthos, Panagiotis; Katsaragakis, Stylianos; Kakaris, Stamatios; Theodorou, Dimitrios; Skottis, Ion

doi:10.1016/j.joms.2006.06.287

Cited by 78 publications

(72 citation statements)

References 26 publications

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“…Signs and symptoms of the neck infection includes persistent neck pain, fever, neck mass, swelling, trismus, odynophagia, dysphonia, subcutaneous emphysema, skin erythema and decreased oral intake in the setting of tooth abscess, pharyngeal infection, or Ludwig's angina [1,6]. The diagnosis of DNM can be difficult, owing to the vagueness of the symptoms [20,21]. Symptoms of mediastinal infection include chest discomfort, dyspnoea, nonproductive cough or respiratory insufficiency [3,5,19].…”

Section: Clinical Presentation and Risk Factorsmentioning

confidence: 99%

“…Two compartments of the prevertebral space of the neck, if infected, can give rise to posterior mediastinitis [6,21]. The more anterior of these compartments is the retropharyngeal space [4,22], which is a common route of spread of DNM infection into the posterior mediastinum [10].…”

Section: Anatomy Classification and Surgical Treatmentmentioning

confidence: 99%

“…In reported cases of DNM, successful surgical management involves a combination of cervical and mediastinal drainage with or without open thoracotomy [3,4,8,15,21,29,30,[36][37][38][39][40][41][42][43][44]. ENDO et al [29] proposed a classification scheme to facilitate management of DNM based on CT assessment of the extent of infection.…”

Section: Review: Descending Necrotising Mediastinitis E Weaver Et Almentioning

confidence: 99%

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Descending necrotising mediastinitis: two case reports and review of the literature

Weaver¹,

Nguyen²,

Brooks³

2010

Eur Respir Rev

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Descending necrotising mediastinitis is a rare and serious infection with a high mortality rate, which complicates pharyngeal or odontogenic infection. Early recognition and treatment are essential in order to minimise morbidity. Evaluation with computed tomography is necessary to confirm the diagnosis and facilitate surgical planning. In addition to prompt empirical antiobiotic therapy, surgical intervention is necessary in nearly all cases. Surgical drainage and debridement may be performed through cervicotomy alone, or through combined cervicotomy and thoracotomy, depending upon the extent of disease. Hyperbaric oxygen therapy may play an auxiliary role. We present two recent cases with characteristic imaging findings, and review the relevant literature. KEYWORDS: Computed tomography, mediastinitis CASE ONEA 60-yr-old male presenting with neck swelling, dysphagia and hoarseness had been extubated 2 days previously following a pneumonia. He had a past medical history of laryngeal cancer treated 10 yrs ago with external beam radiation and chemotherapy. On examination he had bilateral diffuse neck erythema, oedema and right-sided induration. Fibre-optic laryngoscopy showed scabbing of the right hypopharynx and erythematous swelling of the false vocal folds, aryepiglottic folds, and epiglottis. Over the course of 12 h, he developed septic shock with a blood pressure of 70/ 30 mmHg, heart rate of 135 beats?min, and a temperature of 103uF. He was started empirically on vancomycin and piperacillin/tazobactam. After stabilisation in the intensive care unit (ICU), computed tomography (CT) imaging of the neck and chest was performed. There was a large amount of subcutaneous air tracking into the deep fascial planes of the anterior neck, oedematous laryngeal mucosa, and bilateral loculated fluid collections tracking throughout the anterior neck extending to the superior mediastinum ( fig. 1). CT imaging of the chest showed a complex air and fluid collection in the anterior mediastinum extending to the base of the neck ( fig. 2). After review of the images, the patient was taken to the operating room for a combined procedure performed by both head and neck surgeons and thoracic surgeons. Bilateral anterior neck dissections were performed, and blunt dissection, irrigation and debridement were carried out to several centimeters below the sternal manubrium. Penrose drains were left in place. Then, left anterior thoracotomy with debridement of the anterior mediastinum, left pleural decortication and a pericardial window were performed by the thoracic surgeons. Microbiology of the anterior mediastinal fluid grew multiple organisms including Fusobacterium, Prevotella, Bacteroides fragilis, Peptostreptococcus, and a heavy growth of Streptococcus intermedius. Pathology of the pharyngeal lesions showed necrosis and granulation tissue. No neoplasm was identified. The patient later received a tracheostomy and pectoralis myocutaneous flap repair of the neck without sequelae. His total ICU length of stay was 32 days, and hi...

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Section: Clinical Presentation and Risk Factorsmentioning

confidence: 99%

Section: Anatomy Classification and Surgical Treatmentmentioning

confidence: 99%

Section: Review: Descending Necrotising Mediastinitis E Weaver Et Almentioning

confidence: 99%

See 1 more Smart Citation

Descending necrotising mediastinitis: two case reports and review of the literature

Weaver¹,

Nguyen²,

Brooks³

2010

Eur Respir Rev

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“…Mortality, often from overwhelming sepsis, can occur in as many as 40% of cases when the diagnosis is not readily suspected and treatment is delayed [13,14]. Mediastinal abscesses arise from a variety of causes, including head and neck infections, trauma or surgery, and so on [15][16][17].…”

Section: Discussionmentioning

confidence: 99%

Fluoroscopically guided nose tube drainage of mediastinal abscesses in post-operative gastro-oesophageal anastomotic leakage

Guo²,

Chen³

et al. 2012

The British Journal of Radiology

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Objective The aim of this study was to retrospectively evaluate the technical success rates and clinical effectiveness of fluoroscopically guided nose tube drainage of mediastinal abscesses and a nasojejunum feeding tube in post-operative gastro-oesophageal anastomotic leakage (GEAL). Methods From January 2006 to June 2011, 18 cases of post-operative GEAL with mediastinal abscesses after oesophagectomy with intrathoracic oesophagogastric anastomotic procedures for oesophageal and cardiac carcinoma were treated by insertion of a nose drainage tube and nasojejunum feeding tube under fluoroscopic guidance. We evaluated the feasibility of two-tube insertion to facilitate leakage site closure and complete resolution of the abscess, and the patients’ nutritional benefit was also evaluated by checking the serum albumin level between pre- and post-enteral feeding via the feeding tube. Results The two tubes were placed successfully under fluoroscopic guidance in 18 patients (100%). The procedure time for two-tube insertion ranged from 20 to 40 min (mean 30 min). 17 patients (94%) achieved leakage site closure after two-tube insertion and had a good tolerance of two tubes in the nasal cavity. The serum albumin level was significant, increased from pre-enteral feeding (2.49±0.42 g dl−1) to the post-enteral feeding (3.58±0.47 g dl−1) via the feeding tube (p<0.001). The duration of follow-up ranged from 1 to 49 months (mean 19 months). Conclusion The insertion of nose tube drainage and a nasojejunum feeding tube under fluoroscopic guidance is safe, and it provides effective relief from mediastinal abscesses in GEAL after oesophagectomy. Moreover, our findings indicate that two-tube insertion may be used as a selective procedure to treat mediastinal abscesses in post-operative GEAL. Advances in knowledge Directive drainage of mediastinal abscesses in post-operative GEAL may be an effective treatment.

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“…Hava yolu güvenliğinin sağlanması, geniş spektrumlu antibiyoterapi, apse odaklarının drenaj ve debridmanı ve gerekirse yoğun bakım desteği tedavinin bileşenlerini oluşturur. [2][3][4][5] Servikal nekrotizan fasiit olgularının %40-45'inde negatif göğüs içi basınç nedeniyle mediastinal yayılım (desendan nekrotizan mediastinit; DNM) saptanır. [6,7] İlk kez Pearse tarafından 1938 yılında tanımlanan DNM'de SNF retrofarengeal alandan alar fasya aracılığıyla doğrudan arka mediastene veya karotis kılıf aracılığıyla ön mediastene ve perikarda yayılır.…”

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Descending necrotizing mediastinitis secondary to cervical necrotizing fasciitis: Two case reports and contemporary literature

Yılmaz¹

2017

Kulak Burun Bogaz Ihtis Derg

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ÖZServikal nekrotizan fasiit, daha çok yaşlılarda ve immün yetmezliği bulunan hastalarda görülen, polimikrobiyal kökenli, hızlı ve yıkıcı seyreden ve bazen ölümcül olabilen bir derin boyun enfeksiyonudur. Nadiren enfeksiyon derin fasiyal planlar aracılığı ile mediastene yayılır ve desendan nekrotizan mediastenite neden olur. Desendan nekrotizan mediastinit yüksek mortaliteye sahip, acilen tanı konulup tedavi edilmesi gereken ciddi bir tablodur. Bu derlemede biri tip 1, diğeri de tip 2B desendan nekrotizan mediastinit tanısı ile servikal ve mediastinal drenaj ile tedavi edilmiş iki olgu sunuldu ve konu ile ilgili güncel literatür tartışıldı.Anahtar Sözcükler: Servikal nekrotizan fasiit; desendan nekrotizan mediastinit; mediastinoskopi; torakotomi. ABSTRACTCervical necrotizing fasciitis is a polymicrobial, rapidly progressive, destructive, and sometimes fatal deep neck infection, that is most commonly seen in the elderly and immunocompromised patients. The infection rarely spreads to mediastina via deep fascial planes and causes descending necrotizing mediastinitis. Descending necrotizing mediastinitis is a serious clinical entity with a high mortality rate that should be promptly diagnosed and treated. In this review, we present two cases with type 1 and type 2B descending necrotizing mediastinitis treated with servical and mediastinal drainage, and also discuss relevant contemporary literature.

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Descending Necrotizing Anterior Mediastinitis: Analysis of Survival and Surgical Treatment Modalities

Cited by 78 publications

References 26 publications

Descending necrotising mediastinitis: two case reports and review of the literature

Descending necrotising mediastinitis: two case reports and review of the literature

Fluoroscopically guided nose tube drainage of mediastinal abscesses in post-operative gastro-oesophageal anastomotic leakage

Descending necrotizing mediastinitis secondary to cervical necrotizing fasciitis: Two case reports and contemporary literature

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