CT findings of descending necrotising mediastinitis via the carotid space (’Lincoln Highway')

Kono, Tatsuo; Kohno, Atsushi; Kuwashima, Shigeko; Iimura, Fumitoshi; Fujioka, Masashi; Miyata, Rie; Mizusawa, Youichi; Kagawa, F T; Kaneko, Shinichi; Yoshino, Yayoi; Misawa, Masahiro; Ito, Masahiro; Otsuka, Masahiro; Seki, Ichiro

doi:10.1007/s002470000369

Cited by 8 publications

(2 citation statements)

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“…The deep cervical fascia of the neck is composed of a superficial, a visceral and a prevertebral layer, which create the retrovisceral and prevertebral spaces respectively, also named the "danger zone", through which infectious material can dissect from the deep neck soft tissues to the mediastinum [15]. Another pathway of infection spread is through the carotid sheath down into the upper mediastinum, also described as "Lincoln's Highway" [16]. Each of these potential spaces contains loose areolar tissue and readily serves as a site of entry of an oropharyngeal or cervical infection into the chest [17].…”

Section: Discussionmentioning

confidence: 99%

Acute mediastinitis: spectrum of computed tomography findings

Exarhos

Malagari²,

Tsatalou

et al. 2004

Eur Radiol

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The objective of this study was to describe CT findings and to determine the diagnostic value of CT in diagnosis of acute mediastinitis. CT findings were retrospectively studied in 40 patients with suspected acute mediastinitis, including 28 postoperative patients, five with acute descending necrotizing mediastinitis (ADNM), and seven with suspected post-traumatic perforation of the esophagus. Findings included increased attenuation of mediastinal fat (100%), localized mediastinal fluid collections (55%), free gas bubbles in the mediastinum (57.5%), mediastinal lymph nodes (35%), pericardial effusions (27.5%), pleural effusions (85%), lung infiltrates (35%), sternal dehiscence (40%), and pleuromediastinal fistula (2.5%). The sensitivity and specificity of CT in postoperative patients in the first 17 days was 100% and 33% respectively, and after day 17, 100% and 90%. In patients with ADNM sensitivity was 100% while in patients with suspected esophageal perforation sensitivity and specificity were 100%. CT is a highly sensitive technique for the detection of mediastinitis of various causes. For the postoperative patients there is clear time dependence for CT interpretation and accuracy. In patients with suspected ADNM, and traumatic esophageal perforation CT is highly specific early after clinical presentation.

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Section: Discussionmentioning

confidence: 99%

Acute mediastinitis: spectrum of computed tomography findings

Exarhos

Malagari²,

Tsatalou

et al. 2004

Eur Radiol

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“…5 Rare causes of mediastinitis develop as a result of penetrating or blunt trauma, hematogenous spread of infection, and chronic fibrosing mediastinitis due to granulomatous infection. 6,7 The more common causes of mediastinitis with relevance to our case include postoperative mediastinitis following cardiovascular surgery and descending mediastinitis.…”

Section: Introductionmentioning

confidence: 87%

A Rare Case of Mediastinitis Following a Routine Dental Procedure in a Patient with History of Cardiac Surgery

DeMesa¹,

Amley²,

Lam³

et al. 2011

N A J Med Sci

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Mediastinitis is a rare, severe condition associated with increased morbidity and mortality. Mediastinitis, a life-threatening infection, may occur during the postoperative period following cardiovascular surgery. We present a unique case of mediastinitis following a dental procedure in a 47 year old healthy male with a past surgical history of acute type 1 aortic dissection repaired with Dacron tube graft and re-suspension of his aortic valve, 16 months earlier. He was noted to have induration on his right pectoralis muscle and underwent chest Computerized Tomography (CT) scan revealing infectious mediastinitis. His condition improved after CT-guided abscess aspiration and a six-week course of intravenous antibiotics. Mediastinitis may result from an infection extending from the oropharynx inferiorly through deep spaces of the neck as a descending necrotizing mediastinitis. This case suggests that disruption of fascial planes following cardiac surgery may predispose individuals to acquire anterior mediastinitis via a descending pathway long after completion of surgery.

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