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[Mediastinitis with bilateral empyemas following neck phlegmon]
1Department of Respiratory Medicine, Juntendo University, School of Medicine, Tokyo, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi
|January 1, 1992
Summary
A neck phlegmon spread to the chest, causing bilateral empyemas. Prompt antibiotic treatment and pleural drainage successfully managed this severe infection.
Area of Science:
- Infectious Diseases
- Thoracic Surgery
- Radiology
Background:
- Neck phlegmon is a serious infection that can lead to severe complications.
- Pleural empyema, pus in the pleural space, can result from contiguous spread of infection.
- Mediastinal involvement requires careful diagnosis and management.
Observation:
- A 46-year-old male presented with fever and neck swelling, progressing to bilateral pleural empyemas.
- Gram-positive anaerobic cocci were identified in pleural effusion cultures.
- Imaging revealed a continuous infectious lesion from the neck to the mediastinum and bilateral pleural spaces.
Findings:
- The patient's condition improved with intravenous antibiotics and tube thoracostomy for pleural fluid drainage.
- Computed tomography (CT) guided the management, demonstrating the extent of the infection and aiding tube placement.
- No mediastinal abscess requiring surgical intervention was identified on CT.
Implications:
- This case highlights the importance of recognizing and managing neck phlegmon to prevent thoracic complications.
- CT is crucial for delineating the spread of infection and guiding non-surgical management strategies.
- Aggressive antibiotic therapy combined with effective pleural drainage can lead to successful outcomes in complex cases.