Optimal treatment of descending necrotising mediastinitis

Abstract

Abstractfections. In the post-antibiotic era this complication of neck infection is much less Background -Descending necrotising mediastinitis is caused by downward common. Estrera et al 2 reported the largest series since 1960 with 10 cases. We have sucspread of neck infection and has a high fatality rate of 31%. The seriousness of cessfully treated seven adult patients with descending necrotising mediastinitis and also this infection is caused by the absence of barriers in the contiguous fascial planes present a child in whom the infection developed and spread rapidly, leading to death. This paper of neck and mediastinum. Methods -The recent successful treatment reviews these cases and presents a meta-analysis of 24 case reports and 12 series of adult desof seven adult patients with descending necrotising mediastinitis emphasises the cending necrotising mediastinitis since 1970. importance of optimal early drainage of both neck and mediastinum and prolonged antibiotic therapy. The case is also pre-Methods sented of a child with descending ne-  1 crotising mediastinitis, demonstrating the A 35 year old male engineer with a past history rapidity with which the infection can de-of hepatitis B was admitted following transfer velop and lead to death. Twenty four case from the intensive care unit of a peripheral reports and 12 series of adult patients with hospital. Five days prior to admission he had descending necrotising mediastinitis pub-sought medical attention for odynophagia, lished since 1970 were reviewed with meta-hoarseness, and mild left otalgia for which he analysis. In each case of confirmed des-was given oral penicillin. Forty eight hours later cending necrotising mediastinitis the he was admitted to the intensive care unit There were bilateral pleural effusions and lower 19% when mediastinal drainage was added lobe consolidation. The pericardial space was

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

“…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].…”

“…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]. Given that optimal surgical treatment usually requires both cervicotomy and thoracotomy or thoracoscopy, as discussed below, cooperative management by both head and neck surgeons and thoracic surgeons is essential.…”

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

“…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.…”

Mediastinal Irrigation in the Treatment of Descending Necrotizing Mediastinitis

“…Corsten and colleagues reported 19% mortality when they combined transthoracic with transcervical mediastinal drainage approach compared to a 47% mortality rate when only transcervical mediastinal drainage was used. Based on this result, they recommended transcervical and transthoracic mediastinal drainage as the standard approach in the treatment of DNM [10]. Marty-Ane and colleagues [11] in a report where they treated 12 DNM patients with early transthoracic mediastinal drainage reported a 16.5% mortality, Freeman and colleagues in a 10 DNM series treated with combined transcervical and transthoracic drainage had no mortality [12].…”