The clinical analysis of infection of the deep neck space with superior mediastinal abscess

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Objective:To study the etiology, presentation, diagnosis and treatment of infection of deep neck space with superior mediastinal infection in order to accumulate experience in clinical diagnosis and treatment.Method:We reviewed medical records of 15 patients who were diagnosed with deep neck infection with superior mediastinal infection and those who were hospitalized in Guizhou provincial people's hospital from Janurary 2011 to July 2015.The patients were screened retrospectively for demographic characteristics, presenting symptoms, laboratory examinations, imaging features, bacteriologies and etiologies. The treatment and outcomes of the patients were investigated.Result:In 15 patients, 7 cases（46.67%) were related to foreign body in esophagus, 3（20%) cases were related to peritonsillar abscess, 2（13.33%) cases who had diabetes with poor blood glucose control were related to exodontias, 3（20%) cases were related to unknown reasons. The serum CRP［(151.82±22.12)mg/L］ at the time of admission had a positive correlation with the time of hospitalization. The time of CRP decreased to normal range after admission ［(15.3±2.1)d］ were apparently related to the hospitalization time［(23.8±4.1)d］(r=0.79, P<0.01). The results of bacteria culture of 7 cases was positive(46.67%), 2 cases were infected by Klebsiella pneumoniae and 1 case was mixed with Escherichia coli, 2 cases were infected by the Streptococcus viridans infection, 2 cases were infected by Hemolytic streptococcus A group and B group, 1 case was infected by Staphylococcus Aureus. Appropriate antibiotics for organisms were given based on the results of culture identification and empiric therapy. The patients with abscesses were treated with cervical and superior mediastinal drainage. In 15 patients who were complex treatment, 4 patients including 2 patients with diabetes were succumbed to the disease （mortality is 26.67%）,11 patients were healed up(effective rate is 73.33%).Conclusion:The patients with deep neck space infection with superior mediastinal infection had rapid onset, rapid development and the patients with diabetes had high mortality. The patients should be analyzed in detail the history and clinical manifestations combined with imaging examination, bacterial culture and drug sensitive test and so on in order to determine the diagnosis. The patients should be cured with effective antibiotics and active surgical intervention.