Abstract
Descending necrotizing mediastinitis (DNM) is a rare and fatal infection arising from the deep neck tissue and spreading downwards into the mediastinum. We report a case of successful treatment of DNM with empyema. A woman in her seventies visited a neighboring hospital because of fever and a sore throat. The therapy conducted with a diagnosis of acute adenoiditis was ineffective. Six days later, she was transferred to our hospital with a diagnosis of DNM with empyema that was made based on CT findings. We performed emergency operation in partnership with the department of otolaryngology in our hospital. After drainage of the superior mediastinum and tracheostomy, thoracoscopic mediastinal drainage and decortication were performed. Chest CT-scan on the next day revealed effective drainage. She was discharged from our hospital 55 days after the surgery. Preoperative planning of a drainage route and postoperative checking of un-drained area by CT scanning are useful for the prompt and accurate drainage that is of most important in treating DNM.
