Descending necrotizing mediastinitis: Report of three cases and review of literature

Abstract

Descending necrotizing mediastinitis (DNM) is a rare, severe, life-threatening suppurative infection of the fascial covering of mediastinal cavity. Oropharyngeal cavity is connected to the mediastinum with various fascial planes. The retropharyngeal space is called the dangerous space as through this fascial space infection from the mouth and neck rapidly spread to the mediastinum. Gravity and the negative intrathoracic pressure facilitate the spread of infection into the thoracic cavity. Common clinical presentations are fever, odynophagia, dysphonia, dry cough, neck swelling and chest pain. Computerized tomography of neck and chest will diagnose DNM early and it helps in the grading of the disease. Broad spectrum antibiotic therapy and fluid resuscitation with surgical drainage is essential therapeutic aspect. Combination of transcervical and transthoracic drainage is reported to have significantly more survival benefit than the trans-cervical drainage alone. Percutaneous and video-assisted mediastinoscopic drainage has obvious advantages compared with open surgical drainage. We report three cases of DNM, with recurrent laryngeal nerve involvement successfully treated by video-assisted thoracoscopy and percutaneous drainage.