Korean J Thorac Cardiovasc Surg.  1999 Jul;32(7):686-689.

Descending Necrotizing Mediastinitis Secondary to Peritonsillar Abscess: A Case Report

• Choi PJ
• Lee YH
• Woo CS
• Lee GN
• Son CH
• Park HS
• Lee IG

Abstract

Descending necrotizing mediastinitis(DNM) is a rare complication of the oropharyngeal and cervical infection. Descending necrotizing mediastinitis requires an early and aggressive surgical approach to reduce the high morbidity and mortality associated with this disease. A 39-year-old man complained of odynophagia, neck swelling, and disturbance of swallowing with dyspnea. CT scans of the neck suggested a peritonsillar abscess and retropharyngeal and peripharyngeal abscess. He underwent cervical drainage. He remained febrile and complained of severe both pain in both shoulders. On postoperative day 5, a follow-up CT scan confirmed a mediastinal abscess. Reexploration of the neck and right thoracotomy for debridement and drainage of the mediastinal abscess were performed. A large amount of pus was drained from the anterior and posterior mediastinum and its necrotic tissue was debrided. The patient's condition and radiologic findings gradually improved. Cultures of the drain fluid revealed Klebsiella pneumoniae. He was discharged on the 85th hospital day. In our experience, both transcervical drainage and aggressive mediastinal exploration via thoracotomy can lead to an improvement in the survival of the patient with descending necrotizing mediastinitis. CT scanning is useful for early diagnosis of mediastinitis and for follow up.

Keyword

Abscess; Mediastinitis

MeSH Terms

Abscess
Adult
Debridement
Deglutition
Drainage
Dyspnea
Early Diagnosis
Follow-Up Studies
Humans
Klebsiella pneumoniae
Mediastinitis*
Mediastinum
Mortality
Neck
Peritonsillar Abscess*
Shoulder
Suppuration
Thoracotomy
Tomography, X-Ray Computed