2017 Volume 68 Issue 4 Pages 314-319
A mediastinal abscess developing from a deep cervical abscess is an emergent disease having a high mortality rate which requires treatment including immediate drainage. In this study, we report on our experience regarding a case involving an esophageal submucosal abscess requiring differentiation from a mediastinal abscess.
The subject was a 65-year-old female patient with chief complaints of a sore throat and cervical swelling. Obstruction of the airway was observed and endotracheal intubation was carried out as an ambulatory service. CT revealed a left peritonsillar abscess and deep cervical abscess, along with an abscessed lesion developing continuously in the mediastinal direction up to the bifurcation of the trachea. A cervical incision and drainage were conducted the same day. The mediastinal abscess remained, however. Despite conducting another cervical incision, we could not achieve drainage from the mediastinum. During the course of the operation, the abscess further enlarged and the general condition of the patient deteriorated. An esophageal intramural abscess was suspected from the findings. Upon consultation with the Department of Gastrointestinal Surgery, an esophageal submucosal abscess was suspected. We then made an incision under endoscopy, resulting in a large amount of drainage, after which the general condition of the patient rapidly improved.
Contrast-enhanced CT is effective for distinguishing an esophageal submucosal abscess from a mediastinal abscess. In the case of a mediastinal abscess, the abscess cavity can be identified as having developed into the surrounding tissue, while in the case of an esophageal submucosal abscess, a localized abscess cavity is formed in sharp contrast with the surroundings of the abscess. If in doubt, upper endoscopy should be performed. This is a relatively rare disease reported here together with a review of the pertinent literature.
