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Descending necrotizing mediastinitis with diffuse ST elevation mimicking pericarditis: a case report.

Young Soon Cho¹, Jae Hyung Choi¹

¹Department of Emergency Medicine, College of Medicine, Soonchunhyang University, Bucheon-si, Gyeonggi-do, Korea.

The Journal of Emergency Medicine

|July 26, 2014

Summary

Descending necrotizing mediastinitis (DNM) can mimic pericarditis on ECG. Early diagnosis and treatment are crucial for this serious condition, differentiating it from benign viral pericarditis.

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Area of Science:

Cardiology
Infectious Diseases
Thoracic Surgery

Background:

Descending necrotizing mediastinitis (DNM) is a severe infection requiring prompt intervention.
Inflammation in DNM can affect the heart, leading to electrocardiogram (ECG) changes that resemble pericarditis.

Observation:

A case report details a patient presenting with chest pain and ECG findings suggestive of pericarditis.
Diagnostic workup revealed deep-neck infection with extension into the mediastinum, confirming DNM.

Findings:

The patient exhibited ST elevation on ECG, neck tenderness, and a widened mediastinum.
Imaging confirmed retropharyngeal and mediastinal abscesses, necessitating surgical drainage and prolonged antibiotic therapy.

Implications:

Keywords:

ST-segment elevation mediastinitis pericarditis

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This case underscores the necessity of considering DNM in patients with acute ECG abnormalities.
Distinguishing DNM from viral pericarditis is critical for appropriate management and improved patient outcomes.