Descending necrotizing mediastinitis complicating a deep neck infection is a serious and life-threatening disease. We report two cases of mediastinitis complicating a peritonsillar abscess that were successfully treated.

Case 1 was a 78-year-old woman and Case 2 was a 19-year-old woman. The patients presented with a right cervical abscess originating from a right peritonsillar abscess, and drainage of the cervical abscess was carried out immediately after admission, followed by antibiotic therapy. However, both patients eventually developed mediastinitis, and drainage of the mediastinal abscess was carried out by a thoracic surgeon in both. Subsequently, Case 1 developed septic shock and DIC. The duration of hospitalization was 126 days for case 1 and 22 days for Case 2. Based on the clinical course of our cases, we think that “unexpected neutropenia in the presence of obvious infection should be viewed as a red flag sign for the presence of a more serious condition”.

Idiopathic carotidynia is a rare disease of unknown origin characterized by unilateral cervical pain of carotid-sheath origin and soft-tissue infiltration surrounding the carotid sheath on imaging examination. Herein, we report the case of a 65-year-old male who presented with the chief complaint of left cervical pain. Otorhinolaryngological examination showed mild swelling and tenderness of the left carotid sheath. A plain CT showed soft-tissue infiltration surrounding the left carotid sheath at the level of the left hyoid bone. Laboratory test results were normal. These clinical manifestations and the findings of CT were consistent with a diagnosis of idiopathic carotidynia. The above symptoms were relieved by one-day treatment with an anti-inflammatory drug. Although soft-tissue infiltration of the carotid sheath of in cases of carotidynia on contrast-enhanced CT has been described in previous reports, it was observed on plain, non-contrast CT images in this patient, which allowed avoidance of any anxiety from the point of view of potential contrast medium allergy in our case. From the reports in the literature and data from our own case, we propose a revised classification of carotidynia, dividing it into five categories (i.e. idiopathic, migrainous, arteriosclerotic, drug-induced, and others).