2015 Volume 29 Issue 5 Pages 615-621
A 30-year-old man presented with an anterior chest wall swelling and fever of 39°C. He had a history of pneumonia of the right middle lobe 1 year before being referred to our hospital. Computed tomography (CT) revealed an abscess in the anterior mediastinum extending to the subcutaneous tissue. Subcutaneous incisional drainage and intravenous antibiotic treatment were performed. Chest CT after the drainage demonstrated the disappearance of the mediastinal abscess. Ten months after the first drainage, the mediastinal abscess relapsed, and we performed right thoracotomy for the purpose of mediastinal drainage. However, the mediastinal abscess relapsed again 3 months later. We chose a median sternotomy approach for radical treatment of the abscess. In this immunocompetent young male case, the mediastinal abscess is assumed to have arisen from the former pneumonia. As for the surgical treatment of mediastinitis, a median sternotomy approach seems to be used less and less today. The risk of postoperative osteomyelitis of the sternum is a major concern and less-invasive approaches such as video-assisted thoracic surgery (VATS) drainage are preferred recently. Our experience indicates that median sternotomy can be a satisfactory approach for the treatment of recurrent anterior mediastinal abscess.
