title: Cardiac tamponade due to group a streptococcus descending necrotizing mediastinitis: case report of an unusual presentation.
abstract: BACKGROUND
  Cardiac tamponade from necrotizing descending mediastinitis is a rare but life-threatening complication of cervicofacial infections.
  
  
  METHODS
  A 49-year-old woman presented in shock with pleuretic chest pain at a small community clinic. She was transferred to our emergency department where cardiac tamponade was diagnosed and drained. Her initial complete blood count and chest radiography suggested a neoplastic process. She, however, was diagnosed with descending necrotizing mediastinitis due to group A Streptococcus. She underwent surgical drainage and recovered uneventfully. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Descending necrotizing mediastinitis can present with cardiac tamponade and a leukemoid reaction mimicking a neoplastic process. Recognizing this entity allows initiation of potentially life-saving treatments.
authors.affiliation: Department of Emergency Medicine, Centre de santé et de services sociaux de Trois-Rivières, Centre hospitalier affilié universitaire régional, Trois-Rivières, Quebec, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Claveau
authors.affiliation: Department of Intensive Care Medicine, Centre de santé et de services sociaux de Trois-Rivières, Centre hospitalier affilié universitaire régional, Trois-Rivières, Quebec, Canada.
authors.forename: Marie-Josée
authors.initials: MJ
authors.lastname: Bériault
mesh_terms: D002305:Cardiac Tamponade / Q000382:microbiology*; D003937:Diagnosis, Differential; D019115:Fasciitis, Necrotizing / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D005260:Female; D006801:Humans; D008480:Mediastinitis / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis*; D013290:Streptococcal Infections / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D013297:Streptococcus pyogenes
keywords: cardiac tamponade; cervicofacial infection; descending necrotizing mediastinitis; leukemoid reaction; pericardial effusion