A case of an elderly patient treated for descending necrotizing mediastinitis.
We report a case of descending necrotizing mediastinitis (DNM). DNM is a serious infection, and preventing death requires early diagnosis and draining of the infection focus. An 84-year-old man was admitted to our hospital complaining of a swollen neck and pain when swallowing. He had had a tooth extracted at a neighboring dental clinic 2 days previously. Cervicothoracic computed tomography (CT) scan demonstrated gas bubbles and unencapsulated abscesses in the cervical spaces and anterosuperior and posterior mediastinum, extending below the carina. He was diagnosed as DNM caused by odontogenic infection. Cervical drainage was performed, in addition to mediastinal drainage using video-assisted thoracic surgery (VATS). Complications were sepsis, disseminated intravascular coagulation (DIC), and heart failure after surgery, but he recovered following intensive care. This was a lifesaving case of DNM for which mediastinal drainage was performed with VATS.
Department of General Thoracic Surgery, Tokai University Hachioji Hospital, 1838 Ishikawa, Hachioji, Tokyo 192-0032, Japan. asuga@is.icc.u-tokai.ac.jp
Atsushi
A
Suga
Yoshimasa
Y
Inoue
Haruka
H
Takeichi
Shunsuke
S
Yamada
Masayuki
M
Iwazaki
D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D004322:Drainage; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D008482:Mediastinum / Q000473:pathology; D009336:Necrosis / Q000473:pathology; D010146:Pain / Q000209:etiology; D020775:Thoracic Surgery, Video-Assisted