A rare case: Descending necrotizing mediastinitis
1Department of Emergency Medicine, Prof. Dr. Cemil Taşcıoğlu City Hospital
2Department of Emergency Medicine, School of Medicine, Üsküdar University, İstanbul, Turkey
Keywords: Emergency room, mediastinitis, retropharyngeal abscess
Descending necrotizing mediastinitis (DNM) is one of the most critical, and often lethal forms of mediastinitis that develop because of the downward spread of deep neck infections. In this article, we wanted to discuss a case report with DNM secondary to retropharyngeal abscess detected in the emergency department, in accordance with the literature. A 51-year-old male patient presented to the hospital with complaints of fever, sore throat when swallowing, and swelling in the neck. He had no history of any disease, trauma, or surgical intervention. On physical examination of our patient, diffuse hyperemia and edema in the pharyngeal area were detected with swelling, edema, redness, and warmth in the neck, which can be felt on both sides of the trachea with palpation. DNM diagnosis was made by detecting retropharyngeal abscess extending to the mediastinum, mediastinal air images and increased density in adipose tissue with intravenous (IV) contrast-enhanced neck and thorax computed tomography (CT). DNM patients most frequently present with complaints of fever, odynophagia, dyspnea, cervical edema, and pain. The most important clinical finding is edema and hyperemia in the pharynx. Our patient presented to the emergency department with complaints of fever, sore throat when swallowing, and neck swelling, and on physical examination, edema, hyperemia, and temperature increase in the neck region were observed together with hyperemia and edema in the pharyngeal area. Laboratory examinations showed high leukocyte count and C-reactive protein levels. The patient was diagnosed with DNM by performing IV contrast-enhanced cervicothoracic CT imaging and underwent an operation. It should be borne in mind that patients who present to the emergency room with fever, odynophagia, and neck swelling may have a rare but seriously life-threatening DNM.
How to cite this article: Ayvaci BM, Gökdağ E. A rare case: Descending necrotizing mediastinitis. Turk J Emerg Med 2022;22:230-2.
The authors clarify that they have obtained all appropriate patient consent forms. In the consent form, the patient has given his consent for sharing his application status, his physical examination findings, his vital signs, and his radiological imaging study results which can also be published in the journal. The patient realizes that his name and initials will not be published, and due efforts will be made to conceal the identity, but anonymity can not be guaranteed.
• BMA: Conceptualization (lead); resources (lead), writing‑original draft (equal), writing‑review, and editing (equal)
• EG: Writing‑original draft (equal), writing‑review, and editing (equal).