Choe Jae Young, Kim Jong Kun, Lee Dong Eun, Seo Kang Suk, Park Jung Bae, Lee Mi Jin, Ryoo Hyun Wook, Ahn Jae Yun, Moon Sungbae
Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, Korea.
Department of Emergency Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
Clin Exp Emerg Med. 2017 Sep 30;4(3):182-185. doi: 10.15441/ceem.16.197. eCollection 2017 Sep.
Descending necrotizing mediastinitis (DNM) is a rare form of mediastinal infection. Most cases are associated with esophageal rupture. DNM after a trigger point injection in the upper trapezius has not been described previously. We present a case of DNM after a trigger point injection in the upper trapezius. A 70-year-old man visited the emergency department with chest discomfort and fever after a trigger point injection in the left upper trapezius. Chest computed tomography showed evidence of DNM, and antibiotic therapy was immediately administered intravenously. Because of the risk of sudden death, poor prognosis due to underlying disease, and his age, he declined surgical treatment and died of septic shock. Although trigger point injections are generally considered safe, caution should be used in patients with an underlying disease or in the elderly. Early diagnosis, broad-spectrum antibiotics, and aggressive surgical management are essential to improve the prognosis.
下行性坏死性纵隔炎（DNM）是一种罕见的纵隔感染形式。大多数病例与食管破裂有关。此前尚无关于在斜方肌上部进行触发点注射后发生DNM的描述。我们报告一例在斜方肌上部进行触发点注射后发生DNM的病例。一名70岁男性在左斜方肌上部进行触发点注射后，因胸部不适和发热前往急诊科就诊。胸部计算机断层扫描显示有DNM的迹象，立即静脉给予抗生素治疗。由于存在猝死风险、基础疾病导致的预后不良以及他的年龄，他拒绝手术治疗，最终死于感染性休克。尽管触发点注射通常被认为是安全的，但对于有基础疾病的患者或老年人应谨慎使用。早期诊断、广谱抗生素以及积极的手术治疗对于改善预后至关重要。
