2013 Volume 136 Pages 139-144
Descending necrotizing mediastinitis (DNM) can be occasionally caused by cervical deep neck infection and has a high mortality rate. Therefore, we need rapid diagnosis and treatment. The reported strategies for DNM treatment have stressed the need for surgical management and adequate antibiotic administration. We experienced one case of DNM with a deep neck abscess. The patient was a 52-year-old male with acute epiglottitis, so we started antibiotic administration, and although the epiglottitis and inflammatory response were getting better, chest pain and dyspnea gradually occurred. We therefore performed CT scan imaging which showed signs of a gas forming abscess in both the neck and anterior mediastinum. Transcervical mediastinal drainage was performed by otolaryngologists and thoracic surgeons. In spite of the operation, the patient’s respiratory condition was getting worse, and a second operation was required via thoracotomic drainage. We should take account of gas-forming abscess as a severe case, therefore we considered a more extended drainage area and performed an additional operation. CT imaging is very useful for determining whether to perform surgery, including transcervical, mediastinal, or thoracotomic drainage.
