Posterior basal segments atelectasis in descending necrotizing mediastinitis

Abstract

Background:We have observed that patients with descending necrotizing mediastinitis show bilateral lower lobes atelectasis before pleural effusion that finally forms empyema. Successful treatment of mediastinitis emphasizes optimal early drainage of neck, mediastinum, and antibiotic therapy. Methods: Exploratory study to determine the presence of segmental atelectasis as incipient sign of mediastinitis. We studied patients from August 2018 to July 2019 with tomographies. Results: We evaluated 25 patients operated due to Mediastinitis at our hospital, from August 2018 to July 2019. Ten (40%) were females and 15 (60%) were male patients. Twenty-one (84%) patients showed atelectasis and 4 (16%) did not have atelectasis. Of the patients that showed atelectasis, 17 (81%) were bilateral, 2 (9.5%) were right sided, and 2 (9.5%) were left sided. We also analyzed the occurrence of pleural effusion in this group. Fifteen (60%) patients had pleural effusion and 10 (40%) did not. Of the total patients with pleural effusion 11 (73.3%) were bilateral, 3 (20%) of the right side, and 1 (6.6%) of the left side. Conclusions: Atelectasis is a sign that we can find in most patients that will develop empyema and we assume that it is associated with lymph nodes inflammation, but it is necessary to develop other protocols to confirm that hilar lymph congestion is the cause of atelectasis. As atelectasis of lower lobes is a sign of imminent sepsis, we always decide to do mediastinal drainage when we find them associated with neck abscess. We are proposing a modification of the endo classification to decide surgery.