[Descending necrotizing mediastinitis. A diagnosis not to be ignored].
BACKGROUND
Acute descending posterior mediastinitis is a very serious condition which can develop after common ear-nose-throat infections. Clinical manifestations are typical and must be recognized rapidly for early diagnosis.


METHODS
We report two cases. In the first case, a 28-year-old man had a retropharyngeal abscess which fistulized into the left pleural cavity. Three operations were necessary to achieve cure and favorable outcome. In the second case, mediastinitis was diagnosed in a 39-year-old patient following a throat infection. Despite early surgery, outcome was fatal due to development of pericarditis and tamponnade.


CONCLUSIONS
These two cases illustrate the variable course of descending mediastinitis and emphasize the importance of early medicosurgical cure. Treatment is based on intravenous antibiotics using a combination of 2 or 3 drugs at high doses in association with emergency surgery and extensive mediastinal washings. Despite well-conducted treatment, descending necrotizing mediastinitis may lead to a fatal outcome.
Service de Réanimation médicale et d'Assistance respiratoire, Hôpital Gui de Chauliac, Montpellier.
V
V
Moulaire
D
D
Jaffuel
L
L
Landreau
P
P
Tarodo
O
O
Jonquet
D000328:Adult; D001424:Bacterial Infections; D002305:Cardiac Tamponade / Q000209:etiology; D017809:Fatal Outcome; D005402:Fistula / Q000150:complications / Q000601:surgery; D005490:Focal Infection / Q000150:complications / Q000601:surgery; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D009336:Necrosis; D010493:Pericarditis / Q000209:etiology; D010608:Pharyngeal Diseases / Q000382:microbiology; D010994:Pleura / Q000382:microbiology / Q000601:surgery; D010995:Pleural Diseases / Q000150:complications / Q000601:surgery; D017703:Retropharyngeal Abscess / Q000150:complications / Q000601:surgery; D016896:Treatment Outcome
La médiastinite descendante nécrosante. Un diagnostic à ne pas méconnaître.