Descending necrotizing mediastinitis: unique complication of central venous catheterization.
BACKGROUND
Central venous catheter placement is a common procedure in the intensive care unit. However, these devices are not without complications. We describe the first reported case of descending necrotizing mediastinitis secondary to central venous catheterization without evidence of associated vascular perforation.


METHODS
Case report and literature review.


RESULTS
A 24-year-old man developed descending necrotizing mediastinitis after exploratory laparotomy for a gunshot wound. A central venous catheter was presumed to be the source because blood, intraoperative, and catheter tip cultures grew the same Klebsiella organism, and there was no evidence of venous perforation at the initial operation.


CONCLUSIONS
Prompt recognition, adequate operative drainage, and appropriate antibiotics remain the best treatment for descending necrotizing mediastinitis.
Caputo
Francis J
FJ
Department of Surgery, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, New Jersey, USA.
Magnotti
Louis J
LJ
Hauser
Carl J
CJ
Livingston
David H
DH
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001769:Blood / Q000382:microbiology; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D003428:Cross Infection / Q000382:microbiology*; D004864:Equipment and Supplies / Q000382:microbiology; D006801:Humans; D007709:Klebsiella / Q000302:isolation & purification*; D007710:Klebsiella Infections / Q000382:microbiology*; D008297:Male; D008480:Mediastinitis / Q000382:microbiology*; D013902:Radiography, Thoracic; D014057:Tomography, X-Ray Computed
D000900:Anti-Bacterial Agents