title: Descending necrotizing mediastinitis with diffuse ST elevation mimicking pericarditis: a case report.
abstract: BACKGROUND
  Descending necrotizing mediastinitis (DNM) is a potentially fatal disease that requires aggressive treatment, including mediastinal exploration. The inflammation associated with DNM may involve the heart, which produces acute changes in the electrocardiogram (ECG). As a result, the ECG may mimic pericarditis, causing some diagnostic confusion.
  
  
  OBJECTIVE
  The objectives of this case report are to describe a case of DNM presenting electrocardiographically with pericarditis, and to discuss how to differentiate between benign viral pericarditis and DNM, and the management of these two diseases.
  
  
  METHODS
  We present the case of a previously healthy 50-year-old man who presented to the Emergency Department for chest pain and presumed pericarditis. The patient presented with ST elevation on multiple leads on ECG, tenderness in the neck, widened mediastinum on the chest radiograph, and nonspecific laboratory test results. Echocardiography revealed normal ventricle function and the presence of mild pericardial effusion. The emergency physician performed contrast-enhanced neck computed tomography (CT) to rule out deep-neck infection. The CT scan showed marginal rim-enhancing abscesses in the retropharyngeal, bilateral submandibular, and anterior visceral spaces with extension into the thoracic cavity. Contrast-enhanced chest CT was performed consecutively. The final diagnosis was deep-neck infection with DNM. The patient underwent mediastinoscopy-assisted drainage and neck fasciotomy twice and received 7 weeks of therapy with intravenous meropenem.
  
  
  CONCLUSIONS
  The present case highlights the importance of considering a mediastinal cause for acute ECG changes.
authors: Department of Emergency Medicine, College of Medicine, Soonchunhyang University, Bucheon-si, Gyeonggi-do, Korea.
authors: Young Soon
authors: YS
authors: Cho
authors: Department of Emergency Medicine, College of Medicine, Soonchunhyang University, Bucheon-si, Gyeonggi-do, Korea.
authors: Jae Hyung
authors: JH
authors: Choi
mesh_terms: D003937:Diagnosis, Differential; D004562:Electrocardiography; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000175:diagnosis*; D008875:Middle Aged; D010493:Pericarditis / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed
keywords: ST-segment elevation; mediastinitis; pericarditis