Kruyt P M, Boonstra A, Fockens P, Reeders J W, van Lanschot J J
Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
Chest. 1996 May;109(5):1404-7. doi: 10.1378/chest.109.5.1404.
Descending necrotizing mediastinitis (DNM) develops as a complication of an oropharyngeal infection and can be life-threatening. Aggressive therapy is generally advised; usually, treatment consists of cervicomediastinal and transthoracic drainage combined with broad-spectrum antimicrobial therapy, especially when the necrotizing process extends below the level of the fourth thoracic vertebra. A rare case of DNM secondary to a retropharyngeal abscess with fistula to both pleural cavities and to the hypopharynx is reported. The patient was successfully treated by cervicomediastinal surgical drainage and percutaneous drainage of both pleural cavities. In our opinion, even complicated DNM can be treated without aggressive surgery if the patient is in good condition.
下行性坏死性纵隔炎（DNM）是口咽感染的一种并发症，可危及生命。一般建议采取积极治疗；通常，治疗包括颈纵隔和经胸引流联合广谱抗菌治疗，尤其是当坏死过程延伸至第四胸椎水平以下时。本文报告1例罕见的DNM，继发于咽后脓肿并伴有双侧胸腔及下咽瘘。该患者通过颈纵隔手术引流及双侧胸腔经皮引流成功治愈。我们认为，如果患者情况良好，即使是复杂的DNM也可以不进行激进手术而得到治疗。
