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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
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.