TWO SUCCESSFULLY TREATED CASES OF DESCENDING NECROTIZING MEDIASTINITIS CAUSING DEEP CERVICAL INFECTION BY TRANSCERVICAL DRAINAGE AND MEDIASTINAL DRAINAGE WITH VIDEO ASSISTED THORACOTOMY

Abstract

Acute mediastinitis after cardiovascular surgery is the most common cause of acute mediastinitis. Descending necrotizing mediastinitis (DNM) causing deep neck infection is a life threatening disease with a reported mortality of 40%. In this paper we present two cases of DNM which were successfully treated by transcervical drainage with or without mediastinal drainage with video assisted thoracotomy. A 65-year-old man was admitted to the hospital because of dental infection associated with acute medias-tinitis. Transcervical draiange was successful. The patient was discharged in good condition. Another patient, a 46-year-old man was admitted to the hospital because of tonsillitis associated with acute mediastinitis. Transcervical drainage was not enough. Mediastinal drainage and debridement with video assisted thoracotomy were successful in this case. CT of the chest was essential in the diagnosis of mediastinitis. In the treatment of DNM, cervical drainage as well as debridement and drainage with video assisted thoracotomy is advocated to salvage the patient.