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

Abstract

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.

Less invasive management of deep neck infection and descending necrotizing mediastinitis

“…But it is still in dispute about the efficacy of VATS to achieve ideal drainage and irrigation for severe cases. [18,19] Furthermore, there is a negative opinion that transthoracic approach for VATS should be avoided for DNM localized to the upper or anterior mediastinum. In such conditions, mediastinal abscess can be effectively drained by the transcervical approach.…”

Clinical characteristic and management of descending necrotizing mediastinitis: a retrospective study, Dr. Soetomo Hospital, Surabaya

“…There are median sternotomy, posterolateral thoracotomy, clam-shell, subxiphoid, and thoracoscopic. Some studies have reported their advantages and disadvantages for each technique (6,13,14). The surgical management for DNM is radically debriding any necrotic tissue present in the cervical region and the mediastinal space, including drainage from each abscess site and reducing airway obstruction.…”

Subphrenic abscess secondary to cervical abscess and fasciitis from dental focus: case report

“…The global literature reports several cases of mediastinal dissemination of deep cervical abscess [7–10]. Although rare, there are some cases of hepatic abscess through hematogenic dissemination [11–13]; however, abdominal dissemination by contiguity is even rarer, and it occurred in only one case of retroperitoneal localization [14] and another with abdominoperineal extension [15].…”

“…It usually involves polymicrobial infection, both aerobic and anaerobic [2]. Early diagnosis and precise treatment of this pathology in its early stage (before clinical signs of deterioration) are critical in the prognosis of these patients [10].…”

“…Often its diagnosis and treatment are delayed because of the difficulty in identifying the symptoms and the severity of the case. Several chest complications of deep cervical abscess [7–10] have been reported in the literature, but abdominal involvement is uncommon. Some cases of liver abscess through hematogenic dissemination [11–13] from CF have also been reported.…”