A less invasive management of post-thyroidectomy descending necrotizing mediastinitis is feasible: a case report and literature review.
BACKGROUND
Descending necrotizing mediastinitis (DNM) is a life-threatening complication secondary to oropharyngeal abscesses, esophageal perforation, or neck infections spreading into the mediastium, but very uncommon after thyroidectomy. Early diagnosis and close clinical and laboratory monitoring are crucial for patient survival. CT scanning of the cervical and thoracic area is a useful tool for diagnosis and follow-up. Different surgical approaches in the management of DNM have been proposed, the most widely accepted being a combined cervicotomy with lateral thoracotomy procedure.


METHODS
A rare case of DNM with group A ss-hemolytic streptococci, in a 47-year-old patient developing after thyroidectomy for multinodular goiter is presented. A more conservative approach through a cervical incision was followed and thoracic drains for pleural effusion evacuation were inserted. After re-operation, repeated CT scanning for disease progression and prompt surgical wound cleaning were performed. Antibiotic therapy was continued up to one month after release. The patient's recovery was uneventful and continues well.


CONCLUSIONS
To the best of the authors' knowledge this is the second case of post-thyroidectomy DNM reported. According to present data it is recommend that a less invasive approach could be satisfactory when prompt diagnosis is established and the thoracic drainage is effective. This case suggests that repeated postoperative CT scanning and close clinical and laboratory monitoring could make an additional thoracotomy a second-line procedure. Moreover, due to the fact that only two cases of post-thyroidectomy DNM are reported worldwide, therapy of this condition remains an open question.
Nikolaos
Nikolaos D
ND
Department of Cardiothoracic Surgery, Patras University School of Medicine, Patras, Greece.
Apostolakis
Efstratios E
EE
Marangos
Markos N
MN
Koletsis
Efstratios N
EN
Zampakis
Petros
P
Panagopoulos
Konstantinos
K
Dougenis
Dimitrios
D
D001013:Aorta, Thoracic / Q000473:pathology; D003287:Contrast Media / Q000494:pharmacology; D018450:Disease Progression; D005260:Female; D006044:Goiter, Nodular / Q000601:surgery; D006801:Humans; D008477:Mediastinal Diseases / Q000000981:diagnostic imaging; D008480:Mediastinitis / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D008482:Mediastinum / Q000000981:diagnostic imaging; D008875:Middle Aged; D013965:Thyroidectomy / Q000009:adverse effects* / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
D003287:Contrast Media