Descending Necrotizing Mediastinitis Treated by Thoracoscopic Drainage in the Prone Position—A Case Report—

Abstract

A 69-year-old woman with sore throat and arthralgia was provided antimicrobial therapy for 5 days without improvement and was subsequently referred to our hospital. Computed tomography revealed emphysema extending from the left hypopharynx to mediastinum and abscess formation in the inferior mediastinum (Endo's Classification Type II B). Based on these findings, the patient was diagnosed with descending necrotizing mediastinitis, and emergency surgery was performed. Thoracoscopic drainage was performed using a right-sided approach with the patient in prone position. After changing the patient's position from prone to supine, cervical drainage was performed via a collar incision on the left side of the neck. Although left recurrent laryngeal nerve paralysis occurred postoperatively, no tracheotomy was required. The patient was discharged on postoperative day 24. While thoracotomy and mediastinoscopic and thoracoscopic approaches for mediastinal drainage have been reported in descending necrotizing mediastinitis, to date, no report has described drainage by thoracoscopy with the patient in prone position. Herein, we report the successful treatment of descending necrotizing mediastinitis via thoracoscopic drainage with the patient in the prone position.