Two Cases of Descending Necrotizing Mediastinitis Secondary to a Deep Neck Abscess

Abstract

Descending necrotizing mediastinitis (DNM) can be occasionally caused by cervical deep infection and has a high mortality rate. Therefore, strategies for treating DNM have reported the need for surgical management as well as full antibiotics administration. We experienced two cases of DNM with deep neck abscesses. Neck and chest computed tomographic (CT) imaging of our cases revealed typical signs of neck abscesses and gas formation in mediastinum. In case 1, a 57 year-old-male patient could be rescued by both transcervical mediastinal drainage and mediastinal drainage with thoracotomy. Case 2 (a 59 year-old-male) was managed with transcervical mediastinal drainage without thoracotomy due to poor pulmonary function. The patient died on the 37th postoperative day. From our own cases and other reports, we suggest that early diagnosis with chest CT, and aggressive mediastinal drainage with the addition of a thoracotomy would be essential to improve DNM.