Complicated case of patient with cervical necrotising fasciitis and descending necrotizing mediastinitis − case report

2020 ◽  
Vol 99 (4) ◽  
pp. 189-193
Keyword(s):  
Soft Tissues ◽  
Neck Region ◽  
Deep Neck Infection ◽  
Descending Necrotizing Mediastinitis ◽  
Duration Of Treatment ◽  
Complicated Case ◽  
Neck Infection ◽  
Contrast Enhanced Ct ◽  
Life Threatening ◽  
Hospital Stays

Descending necrotizing mediastinitis is a severe, fulminant, life-threatening bacterial infection of the mediastinum. Even though improvements in diagnostics and treatment were achieved, the mortality rate remain shigh. Contrast-enhanced CT of chest and neck is the diagnostic gold standard. Radical debridement and drainage of the mediastinum should be considered the primary therapeutic target. The authors present a complicated case of a female patient with cervical necrotizing fasciitis and descending necrotizing mediastinitis. She was initially treated for a deep neck infection at the department of otorhinolaryngology. Surgical treatment, antibiotics, and intensive care became an integral part of the therapy after the transfer to the department of thoracic surgery. The authors had to face various complications with tracheostomy and extensively debrided soft tissues in the neck region. That is why the patient underwent repeated surgeries during several hospital stays, with an overall duration of treatment reaching 220 days.

scholarly journals Cervical necrotizing fasciitis associated with descending necrotizing mediastinitis

2019 ◽  
Vol 6 ◽  
Author(s):  
Ugur Gonlugur ◽  
Oguz Guclu ◽  
Ozan Karatag ◽  
Arzu Mirici ◽  
Sefa Derekoy
Keyword(s):  
Necrotizing Fasciitis ◽  
Soft Tissues ◽  
Deep Neck Infection ◽  
Descending Necrotizing Mediastinitis ◽  
Connective Tissues ◽  
Neck Infection ◽  
Intravenous Antibiotics ◽  
Mediastinal Drainage ◽  
Painful Neck ◽  
Prompt Diagnosis

We report a case of potentially fatal cervical necrotizing fasciitis and descending necrotizing mediastinitis due to deep neck infection in a 66-year-old male patient with no history or evidence of immunocompromising disorders. On admission, he had painful neck movements and the skin over his neck was red, hot and tender. A computerized tomography (CT) scan of his neck and chest showed evidence of air collection in soft tissues. He was treated with broad-spectrum intravenous antibiotics and early massive cervical drainage. Prompt diagnosis by CT of the neck and chest enabled an early surgical treatment of cervical necrotizing fasciitis. Although acute mediastinitis is a fatal infection involving the connective tissues that fill the interpleural spaces and surround the median thoracic organs, an extensive cervicotomy combined with appropriate antibiotics can prevent the need for mediastinal drainage.

A dangerous cause of airway obstruction: deep neck infection

2020 ◽  
Keyword(s):  
Airway Obstruction ◽  
Upper Airway ◽  
Deep Neck Infection ◽  
Jugular Vein Thrombosis ◽  
Neck Infection ◽  
Vein Thrombosis ◽  
Lethal Complications ◽  
Life Threatening ◽  
Fascial Spaces ◽  
Emergency Doctors

Deep neck infection (DNI) is an infection in the fascial spaces of the neck. Complications of DNI, including mediastinitis, internal jugular vein thrombosis, and upper airway obstruction, are severe and potentially life threatening. Therefore, early identification and accurate management of DNI are essential. We review the anatomy of the deep spaces of the neck to determine the route of DNI spread so that emergency doctors, physicians, and otorhinolaryngologists can quickly recognize the development of lethal complications of DNI, such as asphyxia from airway obstruction.

Descending necrotizing mediastinitis from deep neck infection

2012 ◽  
Vol 270 (4) ◽  
pp. 1463-1466 ◽  
Author(s):  
Hajime Ishinaga ◽  
Kazuya Otsu ◽  
Hiroshi Sakaida ◽  
Tomotaka Miyamura ◽  
Satoshi Nakamura ◽  
...  
Keyword(s):  
Deep Neck Infection ◽  
Descending Necrotizing Mediastinitis ◽  
Neck Infection

Deep Neck Infection Accompanied by Descending Necrotizing Mediastinitis

2015 ◽  
Vol 26 (5) ◽  
pp. e464-e465 ◽  
Author(s):  
Muhammed Sedat Sakat ◽  
Enver Altaş ◽  
Bülent Aktan ◽  
Korhan Kiliç ◽  
Harun Üçüncü
Keyword(s):  
Deep Neck Infection ◽  
Descending Necrotizing Mediastinitis ◽  
Neck Infection

scholarly journals Less invasive management of deep neck infection and descending necrotizing mediastinitis

Medicine ◽  
2017 ◽  
Vol 96 (15) ◽  
pp. e6590 ◽  
Author(s):  
Dong Wei ◽  
Ling Bi ◽  
Huiyong Zhu ◽  
Jianfeng He ◽  
Huiming Wang
Keyword(s):  
Deep Neck Infection ◽  
Descending Necrotizing Mediastinitis ◽  
Neck Infection ◽  
Less Invasive ◽  
Invasive Management

scholarly journals Multidisciplinary treatment of deep neck infection associated with descending necrotizing mediastinitis: a single-centre experience

2019 ◽  
Vol 47 (12) ◽  
pp. 6027-6040 ◽  
Author(s):  
Chao Ma ◽  
Lian Zhou ◽  
Ji-Zhi Zhao ◽  
Run-Tai Lin ◽  
Tao Zhang ◽  
...  
Keyword(s):  
Thoracoscopic Surgery ◽  
Multidisciplinary Treatment ◽  
Multiple Organ ◽  
Deep Neck Infection ◽  
Descending Necrotizing Mediastinitis ◽  
College Hospital ◽  
Odontogenic Infections ◽  
Neck Infection ◽  
Medical College ◽  
Mediastinal Drainage

Objective Deep neck infection (DNI) associated with descending necrotizing mediastinitis (DNM) is a highly lethal condition. This retrospective review was performed to share our experience performing multidisciplinary management of DNI associated with DNM during a 7-year period. Methods We reviewed 16 patients who had been surgically treated for DNM at Peking Union Medical College Hospital from April 2010 to July 2017. The clinical outcomes were analysed to determine the most appropriate therapeutic strategy. Results Five women and 11 men were included in this study. Their mean age was 54.9 ± 14.3 years. DNM-associated infections most commonly occurred secondary to odontogenic infections (n = 10). Thirteen patients required tracheotomy because of tracheal compression. All patients underwent unilateral or bilateral cervicotomy. Six patients with DNM localized in the upper mediastinal space underwent transcervical mediastinal drainage, while 10 patients with DNM extending to the lower mediastinum were treated by cervicotomy and video-assisted thoracoscopic surgery. Three patients died of multiple organ failure. Conclusion Multidisciplinary treatment can achieve favourable outcomes in >80% of patients with DNM. Early diagnosis, proper airway management, and adequate surgical drainage are crucial for reducing mortality in patients with DNM, and minimally invasive procedures also play an important role.

scholarly journals A Case of Descending Necrotizing Mediastinitis Extending from Deep Neck Infection.

2001 ◽  
Vol 94 (12) ◽  
pp. 1117-1122
Author(s):  
Mitsuo TOMINAGA ◽  
Hayato MISAWA ◽  
Masaaki TERANISHI ◽  
Akihide Ito ◽  
Hideo HAYASHI ◽  
...  
Keyword(s):  
Deep Neck Infection ◽  
Descending Necrotizing Mediastinitis ◽  
Neck Infection
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