[Clinical manifestations and lethality of descending necrotizing mediastinitis]

To describe the clinical manifestations, treatment and lethality of a series of patients with descending necrotizing mediastinitis (DNM).

Retrospective study of a series of cases. SITE OF STUDY: The Infectious Diseases Hospital (IDH) of the Mexican Social Security Institute, Mexico City; a national reference hospital.

From January 1996 through December 1998, 18 consecutive patients with diagnostic criteria for DNM were treated in the IDH. Demographic variables, precedents, clinical manifestations, characteristics of paraclinical studies, and treatment results were recollected from the chart of each patient. We made a comparison between patients who survived and the patients who died.

The mean age of the patients was 48.8 +/- 19.1 years; 13 (72.5%) were men. Nine (50%) had an underlying disease, being diabetes mellitus the most frequent one. In 13 (72.5%) cases an odontogenic abscess was the original infection; three (16.6%) patients had retropharyngeal abscesses. The mean time between the beginning of symptoms and admission to the hospital was 10.6 +/- 6.7 days. The most frequent symptoms were fever, dyspnea, dysphagia, and hypotension. The treatment was medical and surgical in all cases, with antibiotics, thoracotomy, drainage and debridement. The most frequent complications were septic shock, nosocomial pneumonia and ARDS. Nine patients died, the lethality rate was 50%. Patients who died had, at admission lower leukocytes and platelets counts; higher glycemia, and developed more frequently cardiovascular complications and septic shock.

Odontogenic abscesses are the most frequent primary infections in patients with DNM. This is an infectious problem with high lethality. Septic shock is the principal cause of death.