Oshima Masahiro, Saito Hiroshi, Kiuchi Ryuta, Nishimura Toshiro, Hirota Kojiro, Horichi Takashi, Kitagawa Kiyohide
Department of Thoracic Surgery, Kouseiren Takaoka Hospital, Takaoka, Japan.
Kyobu Geka. 2011 Feb;64(2):142-5.
A 61-year-old man came to our hospital complained of neck swelling after extracting a tooth. Cervical drainage was performed in the diagnosis of cervical abscess. Two days later, left pleural effusion appeared and its bacteriologic culture showed Streptococcus constellatus. Computed tomography (CT) scan showed massive retained pus in the mediastinum. Thoracic drainage alone wasn't effective and the left thoracotomy was immediately performed to open the mediastinal pleura and curette the thoracic cavity. After surgery, left thoracic cavity was irrigated with a large volume of saline solution via the thoracic drains for a month, resulting in successful recovery. Immediate open drainage and irrigation are very important in case of descending necrotizing mediastinitis rapidly developing empyema.
一名61岁男性因拔牙后颈部肿胀前来我院就诊。诊断为颈部脓肿后进行了颈部引流。两天后，出现左侧胸腔积液，细菌学培养显示为星座链球菌。计算机断层扫描（CT）显示纵隔内大量积脓。单纯胸腔引流无效，立即行左侧开胸手术，打开纵隔胸膜并刮除胸腔。术后，通过胸腔引流管向左侧胸腔内大量灌注生理盐水一个月，最终成功康复。对于迅速发展为脓胸的下行性坏死性纵隔炎，立即进行开放引流和冲洗非常重要。
