A Case of Descending Necrotizing Mediastinitis

概要

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Most cases of deep neck infection are due to oral and pharyngolaryngeal inflammation. Descending necrotizing mediastinitis (DNM) can be occasionally caused by deep neck infection and has a high mortality rate, so rapid diagnosis and treatment are essential. We experienced a case of DNM. The patient was a 76-year-old male with sore throat. CT imaging revealed a neck abscess, so we started antibiotic administration. Despite improvement in the patient's general condition and inflammatory response, he had difficulty in swallowing during the course of the treatment and we performed CT imaging again. An abscess was confirmed in the mediastinum, but a neck abscess was not found at the time. Thoracotomic drainage was performed with antibiotic treatment, and the patient recovered. This case suggests that we should take note of swallowing disturbance as the sign of a potential abscess. CT imaging is very useful for determining whether to perform surgery, including transcervical, mediastinal, or thoracotomic drainage.