Descending necrotizing mediastinitis: a retrospective surgical experience

Sancho, Luis Miguel Melero; Minamoto, Hélio; Fernandez, Ângelo; Sennes, Luiz Ubirajara; Jatene, Fábio Biscegli

doi:10.1016/s1010-7940(99)00168-2

Cited by 105 publications

(76 citation statements)

References 12 publications

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“…anaerobicus, Bacteroides, and Fusobacterium sp [6]. Sancho and colleagues also reported Bacteroides fragilis (%71) to be the most common anaerobic, and Pseudomonas aeruginosa (%43) as the most common aerobic [7]. In our cases we noticed Pseudomonas aeruginosa to be the common anaerobic, and Bacterioides fragilis as the common aerobic bacteria.…”

Section: Discussionsupporting

confidence: 72%

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Mediastinal Irrigation in the Treatment of Descending Necrotizing Mediastinitis

Yazıcı¹

2015

Ann Clin Anal Med

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ÖzetDesendan nekrotizan mediastinit, morbidite ve mortalite riski oldukça yüksek seyreden, nadir görülen klinik bir durumdur. Erken tanı, etkin antibiyoterapi ve cerrahi drenaj tedavi yönetiminin temel prensibini oluşturmaktadır. Kliniğimizde DNM nedeniyle takip ve tedavi edilen iki olgunun tedavi stratejisini sunmak ve daha önceki çalışmalar ile sonuçları karşılaştırmayı amaçladık. Mortalite riski yüksek bu durumun tedavisinin mediastinal ve plevral irrigasyon ile birlikte cerrahi drenaj ve debridman olduğu kanaatindeyiz. Anahtar KelimelerDesendan; Nekrotizan; Mediastinit; Cerrahi; İrrigasyon Abstract Descending necrotizing mediastinitis (DNM) is a rare clinical condition associated with high risk morbidity and mortality rate. Early diagnosis, effective antibiotherapy, and surgical drainage constitute the main principle of management. We present our treatment strategy of two cases of DNM and compare our results with previous studies. We believe the treatment of this high mortality rate condition should include both mediastinal and pleural irrigation together with complete surgical drainage and debridement

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Section: Discussionsupporting

confidence: 72%

“…In our cases we noticed Pseudomonas aeruginosa to be the common anaerobic, and Bacterioides fragilis as the common aerobic bacteria. Hasegawa and colleagues classified DNM into 3 groups [7]. Type I DNM is localized to the upper mediastinum above the trachea bifurcation.…”

Section: Discussionmentioning

confidence: 99%

Mediastinal Irrigation in the Treatment of Descending Necrotizing Mediastinitis

Yazıcı¹

2015

Ann Clin Anal Med

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“…6 The early contrast-enhanced CT of the neck and thorax is the single most important tool for early diagnosis of DNM. [5][6][7][8] Features of DNM on CT include increased density of the adipose tissue, myositis, cervical lymphadenopathy, and/or mediastinal fluid collection (with or without gas). 8 Bilateral empyemas seen on CT are pathognomonic for acute mediastinitis and treatment should begin immediately.…”

Section: Discussionmentioning

confidence: 99%

Acute Mediastinitis as a Complication of Epstein-Barr Virus

Lloyd

Tran

2015

CJEM

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Acute mediastinitis is a rare, potentially life-threatening condition that is most commonly seen as a complication of esophageal perforations or cardiac surgery. The term "descending necrotizing mediastinitis" (DNM) is used to describe oropharyngeal infections that spread to the mediastinum, most commonly following odontogenic infections, peritonsillar or retropharyngeal abscesses, cervical lymphadenitis, trauma, or endotracheal intubation. Infectious mononucleosis is another rare cause of DNM. The mortality of acute mediastinitis is high, while the mortality for DNM is even higher. Major determinants of mortality are delayed diagnosis and/or treatment. While DNM is seen infrequently, its severe nature makes it essential that emergency physicians consider the diagnosis in patients presenting with upper respiratory infections, chest pain, and systemic symptoms, and also in patients with a recent diagnosis of EBV, in order to mitigate a high rate of morbidity and mortality. RÉSUMÉLa médiastinite aiguë est une maladie rare, potentiellement mortelle, qui résulte la plupart du temps d'une perforation de l'oesophage ou d'une opération cardiaque. L'expression « médiastinite nécrosante descendante » (MND) fait référence aux infections oropharyngées, qui se propagent au médiastin; il s'agit en général d'infections odontogènes, de phlegmons périamygdaliens ou d'abcès rétropharyngiens, de lymphadé-nite cervicale, de traumas ou d'intubations endotrachéales. La mononucléose infectieuse donne rarement lieu à une MND. Si la mortalité attribuable à la médiastinite aiguë est élevée, celle attribuable à la MND l'est encore plus. Les principaux déterminants de la mortalité sont un retard dans la pose du diagnostic ou la mise en route du traitement. Bien que les cas de MND soient rares, la gravité de la maladie exige que les médecins d'urgence envisagent le diagnostic chez les patients présentant une infection des voies respiratoires supérieures, des douleurs thoraciques et des symptômes généraux ainsi que chez les patients chez qui une infection à virus Epstein-Barr a été diagnostiquée depuis peu, afin d'abaisser le taux élevé de morbidité et de mortalité. Keywords: EBV, Acute Necrotizing Mediastinitis, Descending Necrotizing Mediastinitis CASE REPORTA previously healthy 39-year-old male initially presented to the emergency department (ED) with an upper respiratory tract infection characterized by cough, nasal congestion, rhinorrhea, bilateral earache with drainage, sore throat, nausea and vomiting. On physical examination, he was found to have bilateral ear effusions and upper airway congestion. He had normal heart sounds and his lungs had equal and clear air entry bilaterally. He had a temperature of 37°C (98.6°F), a heart rate of 113 beats per minute, respiratory rate of 16 breaths per minute, blood pressure of 114/79 mm Hg, and an oxygen saturation of 98% on room air. His chest x-ray was normal. He was diagnosed with a suspected viral illness, likely influenza, and discharged home. Two days later, this patient returned...

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“…[5][6][7][8][9] Nekrotizan enfeksiyon dördüncü torasik vertebra ile trakeal bifurkasyonun oluşturduğu sanal düzlemin üzerinde ise transservikal, aşağısında ise torakotomi ile mediastinal drenajın sağlanması gerektiği öne sürülmüştür. [2,5,9] Ancak, enfeksiyonun hızlı yayılma eğiliminde olması bu yaklaşımın yetersiz kalmasına neden olabilmektedir. Desendan nekrotizan mediastinitde mediastinal drenaj için videotoraksokopik yaklaşım ilk kez Roberts ve ark.…”

Section: Discussionunclassified