Descending Necrotizing Mediastinitis: Mediastinal Drainage With or Without Thoracotomy

Kim, Joung Taek; Kim, K. H.; Lee, S. W.; Sun, Kyung Hoon

doi:10.1055/s-2007-1013168

Cited by 11 publications

(6 citation statements)

References 2 publications

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“…Mediastinal CT scanning highlights the extent of infiltration, and, when any extension under the tracheal bifurcation is discovered, thoracotomy with cervicotomy is the most appropriate therapeutic option. 2,3,15,17,18 Thoracotomy allows access to all mediastinal compartments, efficient excision of all necrotic tissues, and pleural drainage. 15,17 Limited thoracic approaches (mediastinotomy or subxiphoid drainage) allow only limited access, which does not enable adequate detachment and drainage.…”

Section: Discussionmentioning

confidence: 99%

Management of Descending Necrotizing Mediastinitis

et al. 2004

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Descending necrotizing mediastinitis must be detected as soon as possible by computed tomography (CT) scanning in patients with persistent symptomatologia after treatment for oropharyngeal infections. Prompt surgical drainage with thoracotomy and cervicotomy in all cases of mediastinal involvement below the tracheal carena, use of CT scanning to monitor the disease evolution, and medical management in an intensive care unit significantly reduces the mortality rate to less than 20%.

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Section: Discussionmentioning

confidence: 99%

Management of Descending Necrotizing Mediastinitis

et al. 2004

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“…The keystones of therapy are early diagnosis and radical surgery [33,39]. Delay in diagnosis is considered to be the most important preoperative factor for a high mortality rate [12•, 17, 27-29, 34, 37, 39], and inappropriate drainage of the mediastinum is another cause [23,34,40].…”

Section: Management Approachesmentioning

confidence: 99%

“…Endo et al [38] classified DNM into diffuse and localized types according to the degree of diffusion of infection diagnosed by CT, and suggested differential surgical management according to this classification. In DNM type 1, which localizes the infection to the upper mediastinal area above the tracheal bifurcation, transcervical drainage is adequate to drain mediastinal pus [22,35,38,39,41,42].…”

Section: Management Approachesmentioning

confidence: 99%

Update on Necrotizing Mediastinitis: Causes, Approaches to Management, and Outcomes

Sandner

Börgermann

2011

Curr Infect Dis Rep

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Descending necrotizing mediastinitis (DNM) is one of the most feared and fatal forms of mediastinitis, occurring as a complication after odontogenic or cervicofascial infections or after cervical trauma. Delayed recognition, underestimation of the extent of disease, and insufficient therapy promote spread of infection. Primary treatment of DNM includes surgical eradication of the pharyngeal or odontogenic infection focus, and a concomitant major drainage applied to the neck and the mediastinum. However, the mortality rate of DNM remains high, even with the routine use of CT scanning, antibiotics, advancements in anesthesia and intensive care, and immediate surgical drainage. The present state of the optimal management of DNM is discussed controversially, in particular the question of whether thoracotomy should be performed routinely or if minimally invasive procedures (eg, video-assisted thoracoscopy) may be introduced. This review reports on the incidence and course of this disease and discusses management approaches to DNM.

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“…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%

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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Descending Necrotizing Mediastinitis: Mediastinal Drainage With or Without Thoracotomy

Cited by 11 publications

References 2 publications

Management of Descending Necrotizing Mediastinitis

Management of Descending Necrotizing Mediastinitis

Update on Necrotizing Mediastinitis: Causes, Approaches to Management, and Outcomes

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

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