A case of descending necrotizing mediastinitis secondary to a neck abscess

Abstract

A 77-year-old man complained of pharyngalgia and dysphagia, and he consulted a family doctor because ingestion gradually became impossible. He was given an antibiotic, but the symptoms did not improve, and he was referred to otolaryngology in our hospital. Chest CT scan showed a mediastinal abscess. He was diagnosed with descending necrotizing mediastinitis (DNM) and referred to our department. We performed thoracoscopic transthoracic mediastinal drainage on the day following admission. DNM is a serious infection, whereby the abscess of the neck reaches the mediastinum along a muscular fasciae gap. The case fatality rate in the absence of surgery is very high, at 40-50%. The fatality rate on performing surgery, however, can be reduced to 10-20%. Therefore, if DNM is suspected, it is important to perform an early examination for CT and the debridement of necrotic tissue and drainage.