Vol.97 No.11
contentsPRACTICA OTO-RHINO-LARYNGOLOGICA
Vol. 97 No.11 November 2004
Mediastinitis Extending from Deep Neck Infection:
A Report of Two Cases
Jun Watanabe and Masaru Kawasaki
(Nagaoka Red Cross Hospital)
Masayuki Kabeya and Kuniyuki Takahasi
(Niigata University)
Mediastinitis extending from deep neck infection is a very severe disease. We report two cases of cervicomediastinal abscess that were both successfully treated with antibiotics, cervical drainage and transthoracic drainage.
The first case was a 16-year-old man who had a left cervical abscess for which the origin of infection was left mandibular dental caries. Cervical drainage was first performed by a dentist and treated with antibiotics. However, the abscess remained and expanded to the mediastinum on CT scan. At the second operation, cervical drainage and transthoracic drainage was performed by a dentist and thoracic surgeons, but the cervical abscess did not disappear on CT scan. At the third operation, we performed total cervical drainage and the CT scan showed that the abscess had disappeared.
The second case was a 57-year-old woman who had diabetes mellitus. The origin of infection was pharyngitis. The first CT showed a cervical abscess expanding from the upper neck to the mediastinum. We performed a cervical and transthoracic drainage operation with thoracic surgeons. After the operation, she was treated with antibiotics and insulin. Afterwards, the abscess was disappeared perfectly.
Frequent CT scan is very useful in evaluating disease and can help determine the time for surgical treatment. Early and aggressive surgical drainage with collaboration by thoracic surgeons is also very important in severe cases, and will improve the chance of survival in patients with this disease.
Key words : mediastinitis, deep neck infection, cervicomediastinal abscess, drainage, CT scan