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A Journal on Otorhinolaryngology, Head and Neck Surgery,
Plastic Reconstructive Surgery, Otoneurosurgery

Indexed/Abstracted in: EMBASE, Scopus




Otorinolaringologia 2002 March;52(1):31-5

language: Italian

Acute necrotising mediastinitis. A case report

Frenguelli A., Rizzo S., Longari F., Bizzotti C., Bernardini M., Bracchi E.

Università degli Studi - Perugia Azienda Ospedaliera «S. Maria» - Terni Clinica Otorinolaringologica e Chirurgia Cervico-Facciale «R»


Acute nec­rot­is­ing med­i­as­tin­itis is a ­severe poly­mi­cro­bi­al infec­tion of the ­soft tis­sue ­which may in ­some cas­es devel­op ­from an infec­tion of the cer­vic­o­fa­cial dis­tricts. Fortunately, ­reports of ­this evo­lu­tion of the path­o­log­ic pro­cess are ­rare, but the pos­sibil­ity ­should ­always be giv­en due con­sid­er­a­tion. We ­have ­described a ­case of ­acute nec­rot­is­ing med­i­as­tin­itis in a ­young wom­an who was ­referred to our atten­tion ­owing to a swell­ing in the ­oral ­floor, ­fever, tri­smus and pha­ryn­go­dy­nia ­that had ­appeared ­about 10 ­days ear­li­er ­after a ­tooth ­abscess ­that did not ­respond to anti­bi­o­tic treat­ment. The symp­toms wors­ened ­over the ­next 12 ­hours ­with the ­onset of dysp­nea, tach­y­car­dia and inter­scap­u­lar ­pain. Acute med­i­as­tin­itis was diag­nosed and the ­patient was trans­ferred to the ­chest sur­gery ­unit. The clin­i­cal and phys­io­path­o­log­i­cal char­ac­ter­is­tics of ­this ­severe pathol­o­gy are dis­cussed, high­light­ing the impor­tance of ear­ly diag­no­sis and ­prompt treat­ment. The evo­lu­tion of clin­i­cal symp­toms togeth­er ­with instru­men­tal ­tests, ­like ­chest X-ray and com­pu­ter­ised ­axial tomog­ra­phy, ­allowed imme­di­ate diag­no­sis in ­this ­case. Emergency sur­gery and appro­pri­ate anti­bi­o­tics rep­re­sent the elec­tive ­form of treat­ment. The mor­tal­ity ­rate, ­which was par­tic­u­lar­ly ­high ­prior to the ­advent of anti­bi­o­tics, is now ­around 15%. Therapy ­must be imme­di­at­ed and ­based on tar­get­ed anti­bi­o­tic treat­ment ­aimed at ­aerobes and ­anaerobes, cou­pled ­with suit­able sur­gery. Inappropriate meas­ures or ­delays may be ­fatal for the ­patient.

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