A Case of Upper Mediastinal Abscess Due to Cervical Esophageal Perforation Caused by a Pharyngoesophageal Diverticulum That Was Treated by Percutaneous Drainage

Abstract

A 52-year-old man visited a previous hospital with a 3-days’ history of chest pain and respiratory distress. Blood tests showed an elevated inflammatory response. CT showed air around the cervical esophagus, and he was transferred to our hospital. Based on the findings of esophagography and CT, we diagnosed the patient as having an upper mediastinal abscess due to perforation of the cervical esophagus. Ultrasound-guided puncture of the abscess was performed, and a drainage tube was placed in the abscess cavity, which drained brownish-white, cloudy, foul-smelling fluid. The patient was started on antibiotic therapy. Cultures of the abscess fluid grew Bacteroides vulgatus and α-hemolytic streptococci. While the patient remained hospitalized, a new abscess cavity was found, which could also be drained by advancing the drainage tube that was placed initially, resulting in a reduction in the size of the abscess cavity. Esophagoscopy demonstrated a diverticulum in the cervical esophagus. We report a rare case of upper mediastinal abscess caused by rupture of a pharyngoesophageal diverticulum that was successfully treated by percutaneous drainage.