Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2006 Sep 7;124(5):285-90.
doi: 10.1590/s1516-31802006000500011.

Descending mediastinitis: a review

Luis Marcelo Inaco Cirino  1 , Fernando Melhem Elias, José Luiz Jesus de Almeida
Affiliations
Review

Descending mediastinitis: a review

Luis Marcelo Inaco Cirino et al. Sao Paulo Med J. .

Abstract
in English, Portuguese

Context: Mediastinitis is an inflammation of connective tissue that involves mediastinal structures. When the condition has an infectious origin located in the cervical or oral region, it is termed "descending mediastinitis" (DM).

Data sources: The subject was examined in the light of the authors' own experiences and by reviewing the literature available on the subject. The Medline, Lilacs and Cochrane databases were searched for articles, without time limits, screening for the term "descending mediastinitis". The languages used were English and Spanish.

Data synthesis: There are three main fascial pathways by which oral or cervical infections can reach the mediastinum: pretracheal, lateropharyngeal and retropharyngeal. About 70% of DM cases occur via the retropharyngeal pathway. The mortality rate is about 50%. According to infection extent, as seen using computed tomography, DM can be classified as focal (type I) or diffuse (type II). The clinical manifestations are nonspecific and resemble other systemic infections or septic conditions. The primary treatment for DM consists of antibiotics and surgical drainage. There are several approaches to treating DM; the choice of approach depends on the DM type and the surgeon's experience. In spite of all the improvements in knowledge of the microbiology and physiopathology of the disease, controversies still exist regarding the ideal duration of antibiotic therapy and whether tracheostomy is really a necessary procedure.

Conclusion: Since DM is a lethal condition if not promptly treated, it must always be considered to represent an emergency situation.

CONTEXTO:: Mediastinite é um processo inflamatório do tecido conectivo que envolve as estruturas mediastinais. Quando essa condição é causada por uma infecção em sítio cérvico-oral, a inflamação mediastinal é dita mediastinite descendente (MD).

FONTE DE DADOS:: O assunto foi examinado através de revisão da literatura disponível e à luz da experiência dos autores. Os bancos de dados Medline, Lilacs e Cochrane foram pesquisados, sem limite de tempo, através do termo "descending mediastinitis". As línguas utilizadas foram inglês e espanhol.

SÍNTESE DOS DADOS:: Existem três vias fasciais principais pelas quais um foco infecioso em região cérvicooral pode se espalhar para o mediastino: pré-traqueal, latero-faríngeo e retrofaríngeo. Cerca de 70% dos casos de MD ocorrem através da via retrofaríngea. O índice de mortalidade situa-se ao redor de 50%. De acordo com a extensão da infecção e baseado nos achados de tomografia computadorizada (TC), MD pode ser classificada como focal (tipo I) e difusa (tipo II). As manifestações clínicas são inespecíficas e semelhantes às de outras infecções sistêmicas. O tratamento primário da MD consiste em antibióticos e drenagem cirúrgica. Existem diversas formas de abordagem no tratamento cirúrgico da MD; a escolha de qual via será utilizada depende do tipo de MD e da experiência do cirurgião. Apesar de todo o avanço no conhecimento da microbiologia e fisiopatologia da doença, ainda há controvérsias quanto à duração ideal da antibioticoterapia e à necessidade de se realizar traqueostomia nos pacientes portadores de MD.

CONCLUSÃO:: Como a MD é uma condição rapidamente fatal se não diagnosticada e tratada a tempo, ela deve ser sempre considerada uma emergência médica.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: None

Figures

Figure 1
Figure 1. Computed tomography scan of cervical region showing bilateral lateropharyngeal and retropharyngeal collections.
Figure 2
Figure 2. Chest computed tomography scan showing widening of mediastinal region and pleural effusion.
Figure 3
Figure 3. Chest computed tomography scan demonstrating mediastinal collection.
Figure 4
Figure 4. Cervical computed tomography scan showing gas in lateropharyngeal space, and also parapharyngeal and retropharyngeal bilateral abscess.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Akman C, Kantarci F, Cetinkaya S. Imaging in mediastinitis: a systematic review based on aetiology. Clin Radiol. 2004;59(7):573–585. - PubMed
    1. Mihos P, Potaris K, Gakidis I, Papadakis D, Rallis G. Management of descending necrotizing mediastinitis. J Oral Maxillofac Surg. 2004;62(8):966–972. - PubMed
    1. El Oakley RM, Wright JE. Postoperative mediastinitis: classification and management. Ann Thorac Surg. 1996;61(3):1030–1036. - PubMed
    1. Callister ME, Wall RA. Descending necrotizing mediastinitis caused by group A streptococcus (serotype M1T1) Scand J Infect Dis. 2001;33(10):771–772. - PubMed
    1. von Rahden BH, Feith M, Dittler HJ, Stein HJ. Cervical esophageal perforation with severe mediastinitis due to an impacted dental prosthesis. Dis Esophagus. 2002;15(4):340–344. - PubMed

LinkOut - more resources