[Mediastinitis with bilateral empyemas following neck phlegmon].

A 46-year-old male complaining of fever and neck swelling was transferred to our department because of bilateral empyemas in the pleural spaces following neck phlegmon. A culture of the right pleural effusion obtained at his local hospital revealed Gram-positive anaerobic cocci. Chest roentgenogram showed bilateral effusions and widening of the upper mediastinum. Neck roentgenogram confirmed widening of the retropharyngeal space. CT clearly demonstrated a continuous lesion from the neck to the mediastinum and occupying the pleural spaces bilaterally. The patient responded to intravenous antibiotics and tube drainage of the pleural cavities, and was discharged after 10 weeks of hospitalization. Because no mediastinal abscess requiring drainage was recognized on CT, surgical drainage of the mediastinal space was not performed. Sequential CT was used to follow the lesion in the retropharyngeal space, mediastinum and pleural spaces, to check and reposition the tubes for drainage of pleural exudate.