Descending necrotizing mediastinitis

Abstract

Descending necrotizing mediastinitis (DNM) is a rare but severe life threatening complication of oropharyngeal infections. We report a young lady who had severe pharyngitis complicated by anterior neck infection that descended to the mediastinum causing necrotizing mediastinitis. The course of her illness was complicated with septic shock, acute kidney injury, tracheo-esophageal fistula, and critical illness polyneuropathy. There was considerable delay in her diagnosis; however, she survived after aggressive surgical intervention, wide spectrum antibiotics, and appropriate intensive care management. Early and repeated chest imaging using computed tomography was vital for the detection and follow up of this case. There is a need to increase physicians' awareness of this condition that can complicate odontogentic or pharyngeal infection, procedures, or trauma.

Figure 1

Computed tomography of the neck showing significantly enhancing multiloculated collection in the neck, anterior to the trachea (arrow).

Figure 2

Computed tomography of chest showing large well defined loculated cystic collection in the anterior mediastinum, anterior to the heart (big arrow). Bilateral pleural collection (small arrows).

Figure 3

Computed tomography of chest 2 weeks after the surgery showing bilateral lateral thoracic loculated fluid beneath the thoracotomy sites (arrows).

Figure 4

Computed tomography guided aspiration of lateral thoracic loculated fluid (arrow).