Karnath Bernard, Siddiqi Ather
Department of Internal Medicine, University of Texas Medical Branch at Galveston, 77555, USA.
South Med J. 2002 Oct;95(10):1222-5.
Mediastinal abscess resulting from descending necrotizing mediastinitis is a rare infectious process. Odontogenic infections are the most commonly implicated underlying process. Descending necrotizing mediastinitis is a rapidly progressive infectious process that spreads through the fascial planes of the neck to gain access to the mediastinum. Early recognition of descending necrotizing mediastinitis is important because the reported mortality rate is 30% to 50% even in the antibiotic era. Clues to the diagnosis of descending necrotizing mediastinitis include evidence of severe oropharyngeal infection, neck swelling and crepitations, and complaints of dysphagia and odynophagia. Lateral radiographs of the neck sometimes show gas pockets, but chest films are often negative early in the disease process. A late chest x-ray finding is widening of the superior mediastinum. Therefore, computed tomography (CT) is the imaging procedure of choice. Optimal treatment includes adequate drainage of the neck and mediastinum and broad spectrum intravenous antibiotics. Commonly implicated organisms are alpha-hemolytic streptococci and Bacteroides fragilis.
降脓性坏死性纵隔炎导致的纵隔脓肿是一种罕见的感染性疾病。牙源性感染是最常见的潜在病因。降脓性坏死性纵隔炎是一种迅速进展的感染性疾病，可通过颈部筋膜平面蔓延至纵隔。早期识别降脓性坏死性纵隔炎很重要，因为即使在抗生素时代，据报道其死亡率仍为30%至50%。降脓性坏死性纵隔炎的诊断线索包括严重口咽感染、颈部肿胀和捻发音，以及吞咽困难和吞咽痛的主诉。颈部侧位X线片有时可见气肿，但在疾病早期胸部X线片通常为阴性。胸部X线片的晚期表现是上纵隔增宽。因此，计算机断层扫描（CT）是首选的影像学检查方法。最佳治疗包括颈部和纵隔的充分引流以及广谱静脉内抗生素治疗。常见的病原体是甲型溶血性链球菌和脆弱拟杆菌。
