대한흉부영상의학회 Weekly Chest Cases

Case No : 187 Date 2001-05-28

Courtesy of Jeong-Nam Heo, Yo Won Choi, M.D. / Hanyang University Hospital, Seoul, Korea
Age/Sex 56 / M
Chief ComplaintFever, neck swelling

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Diagnosis With Brief Discussion

Diagnosis: Descending Necrotizing Mediastinitis
Radiologic Findings: Chest radiograph shows widening of the superior mediastinum and air pocket at lower neck and left superior mediastinum. CT shows widening of the mediastinum with multiple air densities along with extensive subcutaneous and intramuscular air bubbles.

This patient had odontogenic abscess due to dental caries.
Brief Review: Descending necrotising mediastinitis (DNM) is a form of mediastinitis caused by odontogenic infections or cervical infections such as tonsilitis and pharyngitis. The DNM usually have fulminant course, leading to sepsis and frequently to death. According to the literatures, the mortality rate is ranged from 17 % to 40 %.
The high mortality rate was caused by a number of factors. First was a delay in diagnosis and treatment of the mediastinitis. A delay of a few days resulted in severe complications such as pyothorax, fistula, sepsis. Second factor was stress. Patients with DNM became physically weak due to inadequate nutritional state.
DNM is usually treated by drainage with antibiotics and gamma-globulin administered as supportive therapy. Although various surgical approaches have been reported to treat DNM, such as transcervical drainage, median sternotomy, thoracotomy, and thoracoscopic surgery, the most appopriate operative approach is thoracotomy.
References: 1. Kono T, Kohno A, Kuwashima S, et al. CT findings of descending necrotising mediastinitis via the carotid space (‘Lincoln Highway’) Pediatr Radiol 2001;31:84-86
2. Sakamoto H, Aoki T, Kise Y, et al. Descending necrotizing mediastinitis due to odontogenic infections. Oral Surg Oral Med Oral Pathol Oral Radiol Ecdod 2000;89:412-9
3. Iyoda A, Yusa T, Fujisawa T, et al. Descending necrotizing mediastinitis: Report of a case. Jpn J Surg 1999;29:1209-1212
Keywords: Mediastinum, Infection,

No. of Applicants : 22

▶ Correct Answer : 13/22, 59.1%

- 嫄닿뎅
- 怨
- 諛
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- 源
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- CHU Nancy-Brabois France Denis Regent
- Matsuyama Red Cross Hospital,Matsuyama,Japan Shunya Sunami
- Ospedale di Fabriano, Italy Giancarlo Passarini
- Samsung Medical Center Tae Sung Kim
- Seoul National University Hospital Tae Jung Kim
- St. Andries Hospital Tielt, Belgium Liong DJOA

▶ Semi-Correct Answer : 5/22, 22.7%

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- 遺理湲곕났
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- 源
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대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 187 Date 2001-05-28

Discussion

No. of Applicants : 22