Management of Descending Mediastinal Infections with an Unusual Cause: A Report of3Cases

Dalokay Kilic, MD,1 Alper Findikcioglu, MD,1 Ufuk Ates, PhD,2 Koray Hekimoglu, MD,3 and Ahmet Hatipoglu, MD1

Mediastinal infections are a life-threatening and distinctly rare event, especially when they are caused by a dental abscess or by a foreign body that has not perforated the esophagus. We evaluated how best to treat descending mediastinal infections occurring from an unusual cause. We report 3 female patients with mediastinal infections: two aged 45 and 80 years, each with a dental abscess, and one 62 with a foreign-body injury of the retropharyngeal wall. A retropharyngeal abscess and descending necrotizing mediastinitis developed in two of these patients. The mediastinal abscess was detected by computed tomographic scanning. All patients were successfully treated by drainage of their abscesses via cervicotomy or thoracotomy.
A mediastinal abscess can be a serious complication. Mediastinitis is associated with a high mortality rate if the diagnosis is not quickly established and adequate therapy is not provided. In this report, we discuss the management and possible pathophysiological mechanisms of descending mediastinal infections that have an unusual cause. Clinicians should be aware of the possibility of descending mediastinal infections in patients with a retropharyngeal abscess or a dental abscess associated with persistent signs, such as fever. Imaging modalities must be used as soon as possible to enable early diagnosis. Aggressive treatment includes surgical drainage, and medical management in an intensive care unit may prevent a catastrophic outcome. (Ann Thorac Cardiovasc Surg 2010; 16: 198-202)

Key words: descending mediastinitis, foreign body, retropharyngeal abscess, dental abscess

the Departments of 1Thoracic Surgery; 2Oral and Maxillofacial Surgery; and 3Radiology, Baskent University Faculty of Dentistry, Ankara, Turkey

Received May 17, 2009; accepted for publication June 4, 2009
Address reprint requests to Alper Findikcioglu, MD: Department of Thoracic Surgery, Baskent University Faculty of Medicine, Adana Teaching and Medical Research Center, Dadaloglu M 39. Sok No 6 01250, Yuregir-Adana/Turkey.