Management of Descending Necrotizing Mediastinitis

Makeïeff, M.; Gresillon, N; Berthet, J; Garrel, R.; Crampette, L.; Marty-Ané, Charles; Guerrier, B.

doi:10.1097/00005537-200404000-00035

Cited by 107 publications

(96 citation statements)

References 20 publications

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“…Despite modern therapy, the mortality rate remains high, with reports ranging from 14% to 50% [1,2]. The lethality arises from tissue damage as the infection descends down cervical fascial planes into the mediastinum [3,4]. The term descending necrotising mediastinitis implies the infection …”

Section: Overviewmentioning

confidence: 99%

“…In contrast, DNM is a widespread infection of the neck and mediastinum along deep fascial planes that requires aggressive surgical debridement [1,9,10]. Several case reports and small case series have examined the optimal diagnostic modalities, antibiotic therapy, role of CT scanning and surgical approaches [3,9,[11][12][13][14][15][16][17][18]. Since delay in diagnosis is the primary factor contributing to mortality, the standard of therapy is a comprehensive approach including initial broad spectrum antibiotics, early CT scanning of the neck and thorax, early and wide debridement of cervical and thoracic infection, post-operative ICU monitoring, and surveillance CT scanning and re-operation, as required by clinical course [2,4].…”

Section: Review: Descending Necrotising Mediastinitis E Weaver Et Almentioning

confidence: 99%

“…drug abuse, excessive alcohol intake, AIDS and recent steroid use [3]. DNM is also more common in males [19].…”

Section: Clinical Presentation and Risk Factorsmentioning

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: Overviewmentioning

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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“…This disease is a rare and serious infection with a high mortality rate [14%-50%] that originates from a pharyngeal or dental infection. [17][18][19][20][21] Our patient presented with symptoms similar to those of DNM. The patient's clinical symptoms included the gradual deterioration of neck pain, neck swelling and inflammatory reactions, and the tomographical manifestations included swelling of the retropharyngeal soft tissue, a low-density lesion located in the mediastinum and a pleural or pericardial effusion.…”

Section: Discussionmentioning

confidence: 59%

A Case of an Acute Cervicomediastinal Hematoma Secondary to the Spontaneous Rupture of a Parathyroid Adenoma

Yoshimura

Mukaida

Mimura

et al. 2014

Ann Thorac Cardiovasc Surg

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“…CT not only determines the spread of the inflammatory-necrotic process into the cervical and mediastinal area, but also allows for the determination of the optimal surgical drainage approach (5,7). Treatment of DNM consists of broad-spectrum antibiotic therapy and early drainage of the mediastinum and pleural cavity to remove the cause of infection (5,8,9). Once DNM is diagnosed, antibiotic treatment should be initiated.…”

Section: Discussionmentioning

confidence: 99%

Fatal Dental Abscess: Descending Necrotising Mediastinitis

Şahin¹,

Meteroğlu²,

Toptancı³

et al. 2013

Respir Case Rep

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Mediastinitis is a rare infectious disease around the vital organs in the mediastinum. Descending necrotizing mediastinitis (DNM) is caused by odontogenic, pharyngeal, cervical infections, sternotomy or diagnostic and therapeutic instrumentation. Unless it is diagnosed in a timely manner and properly treated, the outcome is fatal. Delay in treatment leads to the spread of the infection down to the mediatinum. We present a case of DNM in 17-year-old girl suffering from a dental abscess.

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Management of Descending Necrotizing Mediastinitis

Cited by 107 publications

References 20 publications

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

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

A Case of an Acute Cervicomediastinal Hematoma Secondary to the Spontaneous Rupture of a Parathyroid Adenoma

Fatal Dental Abscess: Descending Necrotising Mediastinitis

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