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A Journal on Surgery

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Chirurgia 2008 December;21(6):331-6


language: English

Descending mediastinitis type II: review of the literature

Baikoussis N. G., Beis J. P., Siminelakis S. N.

Department of Cardio-Thoracic Surgery University Hospital, School of Medicine, Ioannina, Greece


Our aim is the study of descending mediastinitis and the review of the international literature. Mediastinitis is an inflammation of connective tissue that involves mediastinal structures. When the condition has an infectious origin located in the cervical or oral region, it is termed “descending mediastinitis” (DM). There are three main fascial pathways by which oral or cervical infections can reach the mediastinum: pretracheal, lateropharyngeal and retropharyngeal. The mortality rate is about 50%. According to infection extent, as seen using computed tomography, DM can be classified as focal (type I) or diffuse (type II). It can be secondary to infectious or non-infectious causes and, depending on the aetiology, it can be acute or chronic. In its acute form, it is a life-threatening condition if not diagnosed early or if treated inadequately. The clinical manifestations are non-specific and resemble other systemic infections or septic conditions. The primary treatment for DM consists of antibiotics and surgical drainage. Since DM is a lethal condition if not promptly treated, it must always be considered to represent an emergency situation. The outcome depends upon the degree of infection and the patient’s underlying disease, and also on the comorbidities. The causes of death are multiple, ranging from septic shock and respiratory insufficiency to gastrointestinal haemorrhages. The most important factor for improving the clinical course, and the course that must be pursued by the healthcare team, is early detection and readily available aggressive treatment.

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