Imaging of descending necrotizing mediastinitis: A report of 11 cases and review of the literature

Abstract

Introduction: Descending necrotizing mediastinitis is a rare and fatal condition that results from the spread of cervicofacial infections to the mediastinum. Early and appropriate management is needed to reduce mortality and morbidity rates. Imaging, especially CT, plays a central role in the diagnosis, treatment, and monitoring of patients. This study is aimed at assessing the role of computed tomography in diagnosing and planning the management of DNM. Material and methods: This is an 8-year retrospective study on 11 patients who fulfilled the ESTRERA criteria. All the patients underwent thoracic radiography along with an enhanced cervicothoracic CT scan. Results: Median age was 34 years with a sex-ratio of 1.75. 4 patients had diabetes. The primary oropharyngeal infection was an odontogenic abscess in most cases. The reported symptoms were mainly thoracic pain and fever. Thoracic radiography and cervicothoracic CT scan confirmed the diagnosis and showed different findings. 7 patients were diagnosed with type I DNM, 1 patient with type IIA and 3 patients with type IIB. Conclusion: DNM is a medico-surgical emergency where imaging, in particular CT, plays an essential role in establishing the diagnosis and guiding the surgical approach to ensure optimal patient care.

Descending Necrotizing Mediastinitis in Healthy Young Adults: The Fatal Consequence of the Delayed Help

“…The preferred modality to set the final diagnosis from the imaging studies is considered to be the CT scan of the head, neck, and chest. It is indicative of confirming the diagnosis and also of giving important information regarding not only the extent, but also the severity of the mediastinal involvement [10]. The treatment consists of a combination of empiric antimicrobial therapy and an optimal surgical drainage approach.…”