title: Descending cervical mediastinitis.
abstract: Descending cervical mediastinitis is an uncommonly reported presentation of infection originating in the head or neck and descending into the mediastinum, which is fraught with impressive morbidity and mortality rates of 30% to 40% or more. We present the INOVA-Fairfax-Alexandria Hospital experience with descending cervical mediastinitis, January 1, 1986, to April 1, 1997; in addition we review the English-language medical and surgical literature with regard to this entity. Computed tomography and magnetic resonance imaging serve to aid both diagnosis and management. The application of broad-spectrum antibiotics should initially be empiric, with an eye to coverage of mixed aerobic and anaerobic infections. Definitive treatment mandates early and aggressive surgical intervention. All affected tissue planes, cervical and mediastinal, must be widely debrided, often leaving them open for frequent packing and irrigation. The treating physician must remain always alert to the further extension of infection, which, if it occurs, must be further debrided and drained. Tracheostomy serves a dual role of further opening cervical fascial planes and securing an often compromised airway.
authors.affiliation: Section of Thoracic Surgery, INOVA Health Systems, Annandale, Virginia, USA.
authors.forename: P D
authors.initials: PD
authors.lastname: Kiernan
authors.forename: A
authors.initials: A
authors.lastname: Hernandez
authors.forename: W D
authors.initials: WD
authors.lastname: Byrne
authors.forename: R
authors.initials: R
authors.lastname: Bloom
authors.forename: B
authors.initials: B
authors.lastname: Dicicco
authors.forename: V
authors.initials: V
authors.lastname: Hetrick
authors.forename: P
authors.initials: P
authors.lastname: Graling
authors.forename: B
authors.initials: B
authors.lastname: Vaughan
mesh_terms: D000038:Abscess / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004322:Drainage; D016724:Empyema, Pleural / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D016983:Enterococcus; D004939:Esophageal Perforation / Q000150:complications; D005260:Female; D005490:Focal Infection / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects; D008297:Male; D008480:Mediastinitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D017703:Retropharyngeal Abscess / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D015819:Substance Abuse, Intravenous; D015996:Survival Rate; D014139:Tracheostomy
chemical_list: D000900:Anti-Bacterial Agents