Biomaterial Database

[Descending necrotizing mediastinitis. A diagnosis not to be ignored]. 1998

V Moulaire, and D Jaffuel, and L Landreau, and P Tarodo, and O Jonquet

Service de Réanimation médicale et d'Assistance respiratoire, Hôpital Gui de Chauliac, Montpellier.

BACKGROUND Acute descending posterior mediastinitis is a very serious condition which can develop after common ear-nose-throat infections. Clinical manifestations are typical and must be recognized rapidly for early diagnosis. METHODS We report two cases. In the first case, a 28-year-old man had a retropharyngeal abscess which fistulized into the left pleural cavity. Three operations were necessary to achieve cure and favorable outcome. In the second case, mediastinitis was diagnosed in a 39-year-old patient following a throat infection. Despite early surgery, outcome was fatal due to development of pericarditis and tamponnade. CONCLUSIONS These two cases illustrate the variable course of descending mediastinitis and emphasize the importance of early medicosurgical cure. Treatment is based on intravenous antibiotics using a combination of 2 or 3 drugs at high doses in association with emergency surgery and extensive mediastinal washings. Despite well-conducted treatment, descending necrotizing mediastinitis may lead to a fatal outcome.

UI	MeSH Term	Description	Entries
D008297	Male		Males
D008480	Mediastinitis	Inflammation of the mediastinum, the area between the pleural sacs.	Mediastinum Inflammation,Inflammation, Mediastinum,Inflammations, Mediastinum,Mediastinitides,Mediastinum Inflammations
D009336	Necrosis	The death of cells in an organ or tissue due to disease, injury or failure of the blood supply.
D010493	Pericarditis	Inflammation of the PERICARDIUM from various origins, such as infection, neoplasm, autoimmune process, injuries, or drug-induced. Pericarditis usually leads to PERICARDIAL EFFUSION, or CONSTRICTIVE PERICARDITIS.	Pleuropericarditis
D010608	Pharyngeal Diseases	Pathological processes involving the PHARYNX.	Diseases of Pharynx,Pharynx Diseases,Disease, Pharyngeal,Disease, Pharynx,Diseases, Pharyngeal,Diseases, Pharynx,Pharyngeal Disease,Pharynx Disease
D010994	Pleura	The thin serous membrane enveloping the lungs (LUNG) and lining the THORACIC CAVITY. Pleura consist of two layers, the inner visceral pleura lying next to the pulmonary parenchyma and the outer parietal pleura. Between the two layers is the PLEURAL CAVITY which contains a thin film of liquid.	Parietal Pleura,Visceral Pleura,Pleura, Parietal,Pleura, Visceral
D010995	Pleural Diseases	Diseases involving the PLEURA.	Disease, Pleural,Diseases, Pleural,Pleural Disease
D002305	Cardiac Tamponade	Compression of the heart by accumulated fluid (PERICARDIAL EFFUSION) or blood (HEMOPERICARDIUM) in the PERICARDIUM surrounding the heart. The affected cardiac functions and CARDIAC OUTPUT can range from minimal to total hemodynamic collapse.	Pericardial Tamponade,Cardiac Tamponades,Pericardial Tamponades,Tamponade, Cardiac,Tamponade, Pericardial,Tamponades, Cardiac,Tamponades, Pericardial
D005402	Fistula	Abnormal communication most commonly seen between two internal organs, or between an internal organ and the surface of the body.	Fistulas
D005490	Focal Infection	An infection at a specific location that may spread to another region of the body.	Focal Infections,Infection, Focal,Infections, Focal