Empyema and mediastinitis complicating retropharyngeal abscess.

Watanabe, Masahiro; Ohshika, Y; Aoki, Teruyuki; Takagi, Kazuya; Tanaka, Shigebumi; Ogata, Toru

doi:10.1136/thx.49.11.1179

Cited by 13 publications

(5 citation statements)

References 6 publications

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“…We thus assume that in the present case not only sepsis but also massive abscess accumulating in the retropharyngeal space spreading behind the alar fascia formed the posterior mediastinal abscess, followed by migration of pus into the pleural cavity. 9 Moreover, pericardial effusion was also found in our case, given the fact that pretracheal layer fuses with the pericardium. Therefore, the different spaces involved in the neck fascial layer may give rise to complications, such as empyema or pericardial effusion.…”

Section: Discussionsupporting

confidence: 65%

“…Our case is unique in that severe empyema developed only 1 day after the mediastinitis was found. We thus assume that in the present case not only sepsis but also massive abscess accumulating in the retropharyngeal space spreading behind the alar fascia formed the posterior mediastinal abscess, followed by migration of pus into the pleural cavity . Moreover, pericardial effusion was also found in our case, given the fact that pretracheal layer fuses with the pericardium.…”

Section: Discussionsupporting

confidence: 51%

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Management of descending necrotizing mediastinitis complicated with empyema by video‐assisted thoracoscopic surgery

Chen

Hsu

Dai

2015

Pediatric Pulmonology

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Descending necrotizing mediastinitis (DNM) is an uncommon disease that can cause significant morbidity and mortality. Herein, we report a 17-month-old girl of DNM with an initial normal chest radiograph followed by rapid clinical deterioration during a period of 4 days, from deep neck infection to mediastinitis and then complicated empyema. She was managed successfully with intravenous antibiotics and surgical debridement by video-assisted thoracic surgery (VATS) and cervical drainage. Early recognition and meticulous intensive care of patients with DNM are important to minimize morbidity and mortality. VATS is an effective and minimally invasive therapeutic strategy in children with DNM.

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Section: Discussionsupporting

confidence: 65%

Section: Discussionsupporting

confidence: 51%

Management of descending necrotizing mediastinitis complicated with empyema by video‐assisted thoracoscopic surgery

Chen

Hsu

Dai

2015

Pediatric Pulmonology

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“…Danger space infection can result from rupture of a retropharyngeal space abscess through the alar fascia [10,34,35].…”

Section: Review: Descending Necrotising Mediastinitis E Weaver Et Almentioning

confidence: 99%

Descending necrotising mediastinitis: two case reports and review of the literature

Weaver¹,

Nguyen²,

Brooks³

2010

Eur Respir Rev

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Descending necrotising mediastinitis is a rare and serious infection with a high mortality rate, which complicates pharyngeal or odontogenic infection. Early recognition and treatment are essential in order to minimise morbidity. Evaluation with computed tomography is necessary to confirm the diagnosis and facilitate surgical planning. In addition to prompt empirical antiobiotic therapy, surgical intervention is necessary in nearly all cases. Surgical drainage and debridement may be performed through cervicotomy alone, or through combined cervicotomy and thoracotomy, depending upon the extent of disease. Hyperbaric oxygen therapy may play an auxiliary role. We present two recent cases with characteristic imaging findings, and review the relevant literature. KEYWORDS: Computed tomography, mediastinitis CASE ONEA 60-yr-old male presenting with neck swelling, dysphagia and hoarseness had been extubated 2 days previously following a pneumonia. He had a past medical history of laryngeal cancer treated 10 yrs ago with external beam radiation and chemotherapy. On examination he had bilateral diffuse neck erythema, oedema and right-sided induration. Fibre-optic laryngoscopy showed scabbing of the right hypopharynx and erythematous swelling of the false vocal folds, aryepiglottic folds, and epiglottis. Over the course of 12 h, he developed septic shock with a blood pressure of 70/ 30 mmHg, heart rate of 135 beats?min, and a temperature of 103uF. He was started empirically on vancomycin and piperacillin/tazobactam. After stabilisation in the intensive care unit (ICU), computed tomography (CT) imaging of the neck and chest was performed. There was a large amount of subcutaneous air tracking into the deep fascial planes of the anterior neck, oedematous laryngeal mucosa, and bilateral loculated fluid collections tracking throughout the anterior neck extending to the superior mediastinum ( fig. 1). CT imaging of the chest showed a complex air and fluid collection in the anterior mediastinum extending to the base of the neck ( fig. 2). After review of the images, the patient was taken to the operating room for a combined procedure performed by both head and neck surgeons and thoracic surgeons. Bilateral anterior neck dissections were performed, and blunt dissection, irrigation and debridement were carried out to several centimeters below the sternal manubrium. Penrose drains were left in place. Then, left anterior thoracotomy with debridement of the anterior mediastinum, left pleural decortication and a pericardial window were performed by the thoracic surgeons. Microbiology of the anterior mediastinal fluid grew multiple organisms including Fusobacterium, Prevotella, Bacteroides fragilis, Peptostreptococcus, and a heavy growth of Streptococcus intermedius. Pathology of the pharyngeal lesions showed necrosis and granulation tissue. No neoplasm was identified. The patient later received a tracheostomy and pectoralis myocutaneous flap repair of the neck without sequelae. His total ICU length of stay was 32 days, and hi...

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“…Posterior to the retropharyngeal space is the danger space, separated from the retropharyngeal space by the alar fascia. Infection in the danger space most commonly occurs when an abscess in the retropharyngeal space ruptures through the alar fascia (13)(14)(15). On CT, it may be difficult to differentiate midline retropharyngeal abscesses from danger space abscesses.…”

Section: Discussionmentioning

confidence: 99%

Association between deep neck space abscesses and internal carotid artery narrowing in pediatric patients

Derinkuyu¹,

Boyunağa²,

Polat³

et al. 2017

Turk J Med Sci

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Background/aim: Our aim was to interpret the effects of deep neck space abscesses on the adjacent carotid artery according to abscess location, as well as to determine narrowing by calculating the mean stenosis ratios.Materials and methods: Neck computed tomography scans and clinical data of 45 children with neck abscesses were evaluated retrospectively for abscess location and internal carotid artery narrowing. The lumen areas of the carotid arteries were measured from standard levels, and stenosis ratios were calculated with two different techniques. The mean stenosis ratios of each group according to abscess location were then compared with the control group.Results: Among the 45 abscesses included in the study, 51.1% (n = 23/45) were located in the peritonsillar region, 37.8% (n = 17/45) were located in the parapharyngeal-lateral retropharyngeal space, and 11.1% (n = 5/45) were in the midline retropharyngeal space. We found a statistically significant difference between the mean stenosis ratios of the ipsilateral side of the parapharyngeal-lateral retropharyngeal abscesses and the control group (P < 0.01).Conclusion: The children with parapharyngeal-lateral retropharyngeal abscesses all had narrowing in the adjacent carotid lumen to some degree. Although most of the patients had no clinical symptoms, radiologists have to be aware of this arterial complication to prevent further progress and fatal complications.

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Empyema and mediastinitis complicating retropharyngeal abscess.

Cited by 13 publications

References 6 publications

Management of descending necrotizing mediastinitis complicated with empyema by video‐assisted thoracoscopic surgery

Management of descending necrotizing mediastinitis complicated with empyema by video‐assisted thoracoscopic surgery

Descending necrotising mediastinitis: two case reports and review of the literature

Association between deep neck space abscesses and internal carotid artery narrowing in pediatric patients

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