[Descending necrotizing mediastinitis: the need for early diagnosis and aggressive treatment]

Three patients developed descending necrotizing mediastinitis (DNM): a 44-year-old man due to poor dental status; a 54-year-old women due to a throat infection, 6 weeks after a tooth extraction; and a 30-year-old man a few days after a tooth extraction. Presenting symptoms were dyspnoea, fever, trismus, cervical oedema, and pain. The first two patients had multiple drainage of the cervical region and mediastinum in combination with pathogen-specific antibiotics. Both recovered without any complications. The third patient probably had inadequate surgical drainage of the mediastinum directly after diagnosis, and died. If the CT scan is suggestive of DNM, the patient should be referred to a thoracic surgical unit immediately. The optimal treatment consists of vigorous surgical drainage of both the neck and mediastinum with irrigation in combination with pathogen-specific antibiotic therapy. An early diagnosis followed by adequate antibiotic and surgical treatment improves the outcome in patients with DNM.