降下性縦隔炎の２例

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  • TWO CASES OF DESCENDING MEDIASTINITIS

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We report two cases of descending mediastinitis. Case 1 was a 58-year-old woman. The inflammation due to a hypopharyngeal abscess spreading continuously from the cervical region to the mediastinum. CT also revealed a low density area with gas formation continuing from the cervical region into the mediastinal level of 4cm under the tracheal bifurcation. Descending necrotizing mediastinitis was diagnosed. The patient was cured by cervical and mediastinoscopic drainage. Case 2 was a 78-year-old man. At Neck and chest MRI demonstrated high intensity continuously from the neck to the mediastinum on T2-weighted image. Necrotizing mediastinitis was diagnosed. However, mediastinoscopy revealed the presence of only mediastinal inflammation and no abscess. The patient was cured by drainage of the cervical abscess.<br> The diagnosis of descending necrotizing mediastinitis should be made not only by the high intensity on T2-weighted MRI, but also by the presence of a gas shadow or niveau formed by anaerobic organisms on chest CT. Furthermore, cervical mediastinoscopy is useful for the drainage of a mediastinal abscess presenting under the tracheal bifurcation.

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