A CASE OF DESCENDING NECROTIZING MEDIASTINITIS

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  • 降下性壊死性縦隔炎の１例

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Abstract

This paper deals with a case of descending necrotizing mediastinitis which presented with acute pharyngitis and then widely extended to the neck and mediastinum.<br> A 71-year-old woman, who had been treated for acute pharyngitis, complained of a sore throat and neck swelling and was diagnosed as having descending necrotizing mediastinitis (DNM). CT scanning of the neck showed a broad neck abscess that extended to the lower mediastinum despite surgical cervical drainage. She underwent combination therapies in our Intensive Care Unit including aggressive medica-tion with antibiotics, mediastinal drainage via open thoracotomy, and continuous hemodiafiltration. The patient recovered 5 months after hospitalization. We conclude that DNM requires early diagnosis, appropriate surgical intervention and intensive systemic treatments. Open thoracotomy on the right side of the thorax should be performed to drain a broad abscess in the mediastinum once DNM expands bilaterally.

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