title: Descending necrotizing mediastinitis: a conservative approach.
abstract: Descending necrotizing mediastinitis (DNM) is a now-rare complication of dental and pharyngeal infections. Reports in the literature have emphasized the need for early, aggressive surgical intervention. We present a case of DNM with bilateral empyemas that arose secondary to a perforated pharyngeal abscess. The patient was successfully managed conservatively with intravenous antibiotics and intercostal drainage. We conclude that conservative management with antibiotics and image-guided percutaneous pleural drainage may be initially appropriate for the stable patient.
authors.affiliation: Department of Respiratory Medicine, Macclesfield District General Hospital, East Cheshire NHS Trust, Victoria Rd., Macclesfield, Cheshire SK10 3BL, UK. countram@gmail.com.
authors.forename: Sriram
authors.initials: S
authors.lastname: Iyer
authors.forename: Joseph
authors.initials: J
authors.lastname: Collum
authors.forename: Marta
authors.initials: M
authors.lastname: Babores
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016866:Bacteroidaceae Infections / Q000000981:diagnostic imaging / Q000628:therapy; D015505:Chest Tubes; D004322:Drainage; D016724:Empyema, Pleural / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D006192:Haemophilus Infections / Q000000981:diagnostic imaging / Q000628:therapy; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D008482:Mediastinum / Q000473:pathology*; D008875:Middle Aged; D009336:Necrosis / Q000000981:diagnostic imaging / Q000628:therapy; D010397:Penicillanic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000039:Peritonsillar Abscess / Q000150:complications*; D010878:Piperacillin / Q000627:therapeutic use; D000077725:Piperacillin, Tazobactam Drug Combination; D012422:Rupture, Spontaneous; D013290:Streptococcal Infections / Q000000981:diagnostic imaging / Q000628:therapy; D014057:Tomography, X-Ray Computed
chemical_list: D000900:Anti-Bacterial Agents; D000077725:Piperacillin, Tazobactam Drug Combination; D010397:Penicillanic Acid; D010878:Piperacillin