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Case Reports
. 2024 Dec 27;16(12):e76459.
doi: 10.7759/cureus.76459. eCollection 2024 Dec.

Descending Necrotizing Mediastinitis: A Rare Yet Lethal Complication Demanding Timely Intervention

Anastasia Kosmidou  1 , Panagiota Kosmidou  2   3 , Ioannis Karamatzanis  4 , Eleni Flari  5   6 , Sofia Pouriki  7 , Panagiotis Κ Nikolopoulos  7
Affiliations
Case Reports

Descending Necrotizing Mediastinitis: A Rare Yet Lethal Complication Demanding Timely Intervention

Anastasia Kosmidou et al. Cureus. .

Abstract

Descending necrotizing mediastinitis (DNM) is a rare and potentially life-threatening condition characterized by the rapid spread of infection within the mediastinum. This severe form of mediastinitis poses a significant challenge to clinicians due to its aggressive nature and potential for rapid deterioration. In this case report, we present a challenging case of descending necrotizing mediastinitis in a 39-year-old patient with persistent pyrexia and an extended hospital stay in the intensive care unit (ICU), cardiothoracic unit (CTU), and surgical intensive care unit (SICU). The step-by-step clinical course, diagnostic challenges, and therapeutic strategies will be discussed in detail. This case highlights the importance of early recognition and a comprehensive, interdisciplinary approach in managing this rare yet lethal mediastinitis.

Keywords: descending mediastinitis; descending necrotizing mediastinitis; ent pathology; mediastinitis management; multidisciplinary management.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. The patient's chest X-ray on admission.
The presence of the widening and haziness of the mediastinum as indicated by the white arrow prompted further investigations.
Figure 2
Figure 2. CT of the neck showing the 4.5 cm abscess in the submandibular-submental space.
CT: computed tomography
Figure 3
Figure 3. Illustration of the position of the extracted tooth.
Image credit: Nikos Kosmidis
Figure 4
Figure 4. CT of the neck showing the presence of air following the excision of abscess (day 5).
CT: computed tomography
Figure 5
Figure 5. Chest X-ray showing new, left-sided pleural effusion on the day of transfer to the MICU (day 6 of hospitalization).
MICU: medical intensive care unit
Figure 6
Figure 6. Final X-ray taken before discharge.
The pleural effusion seen in the previous X-ray has resolved.
See this image and copyright information in PMC

References

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