Lloyd Taryn, Tran Vu Kiet
*University of Toronto,Toronto,ON.
CJEM. 2016 Mar;18(2):149-51. doi: 10.1017/cem.2015.30. Epub 2015 May 26.
Acute mediastinitis is a rare, potentially life-threatening condition that is most commonly seen as a complication of esophageal perforations or cardiac surgery. The term "descending necrotizing mediastinitis" (DNM) is used to describe oropharyngeal infections that spread to the mediastinum, most commonly following odontogenic infections, peritonsillar or retropharyngeal abscesses, cervical lymphadenitis, trauma, or endotracheal intubation. Infectious mononucleosis is another rare cause of DNM. The mortality of acute mediastinitis is high, while the mortality for DNM is even higher. Major determinants of mortality are delayed diagnosis and/or treatment. While DNM is seen infrequently, its severe nature makes it essential that emergency physicians consider the diagnosis in patients presenting with upper respiratory infections, chest pain, and systemic symptoms, and also in patients with a recent diagnosis of EBV, in order to mitigate a high rate of morbidity and mortality.
急性纵隔炎是一种罕见的、可能危及生命的疾病，最常见于食管穿孔或心脏手术的并发症。“下行性坏死性纵隔炎”（DNM）一词用于描述蔓延至纵隔的口咽感染，最常见于牙源性感染、扁桃体周围或咽后脓肿、颈淋巴结炎、创伤或气管插管之后。传染性单核细胞增多症是DNM的另一种罕见病因。急性纵隔炎的死亡率很高，而DNM的死亡率更高。死亡率的主要决定因素是诊断和/或治疗延迟。虽然DNM并不常见，但其严重性使得急诊医生必须考虑对上呼吸道感染、胸痛和全身症状的患者以及近期诊断为EBV的患者进行诊断，以降低高发病率和死亡率。
