Oshima Kazuya, Sugano Yoshiya, Yoshida Akihito, Uegami Wataru, Van Sickels Nicholas, Kobayashi Takaaki, Eguchi Tadashi
Department of General Internal Medicine, Kameda Medical Center, Kamogawa, Chiba, Japan.
Department of Pathology, Kameda Medical Center, Kamogawa, Chiba, Japan.
IDCases. 2024 Sep 7;38:e02078. doi: 10.1016/j.idcr.2024.e02078. eCollection 2024.
can lead to bacteremia in elderly individuals with underlying conditions, primarily from cellulitis. Although rare, mediastinal abscesses can develop from anatomical anomalies, post-thoracic surgery, esophageal rupture, or inflammation in the oral cavity or neck. Aorto-esophageal fistula, a life-threatening condition causing severe bleeding, typically arises from thoracic aortic aneurysms with atherosclerosis. We present a case of recurrent bacteremia complicated by mediastinal abscess and aorto-esophageal fistula in a patient undergoing treatment for gastric cancer. Initial imaging suggested lymph node metastasis, with a diagnosis of abscess only confirmed at autopsy. Although the exact etiology of the abscess was unclear, we highly suspect the recurrent bacteremia contributed to its development via hematogenous spread. Autopsy also revealed progression of the mediastinal abscess into the esophagus and aorta, leading to the formation of a fistula, massive hemorrhage, and ultimately, the patient's death. While uncommon, a mediastinal abscess should be recognized as a potential cause of aorto-esophageal fistula.
在患有基础疾病的老年人中，主要由蜂窝织炎可导致菌血症。纵隔脓肿虽然罕见，但可由解剖异常、胸外科手术后、食管破裂或口腔或颈部炎症引起。主动脉-食管瘘是一种危及生命的疾病，可导致严重出血，通常由伴有动脉粥样硬化的胸主动脉瘤引起。我们报告一例在接受胃癌治疗的患者中发生复发性菌血症，并伴有纵隔脓肿和主动脉-食管瘘的病例。最初的影像学检查提示有淋巴结转移，仅在尸检时才确诊为脓肿。虽然脓肿的确切病因尚不清楚，但我们高度怀疑复发性菌血症通过血行播散促成了脓肿的形成。尸检还发现纵隔脓肿蔓延至食管和主动脉，导致瘘管形成、大量出血，最终导致患者死亡。纵隔脓肿虽不常见，但应被视为主动脉-食管瘘的潜在病因。
