DESCENDING NECROTIZING MEDIASTINITIS SECONDARY TO RETROPHARYNGEAL ABSCESS

Area of Science:

• Medicine
• Infectious Diseases
• Surgical Pathology

Background:

• Descending necrotizing mediastinitis (DNM) is a rare but life-threatening complication of deep neck infections.
• It often occurs in immunocompromised individuals and requires aggressive, multidisciplinary management.

Observation:

• A 70-year-old male with insulin-dependent diabetes mellitus presented with a nontraumatic retropharyngeal abscess.
• Despite initial antibiotic therapy and transoral incision, the patient's condition rapidly deteriorated with fever, chest pain, and hemodynamic instability.
• Computed tomography (CT) revealed retropharyngeal abscess with mediastinal involvement.

Findings:

• Emergency cervicotomy and drainage of the retropharyngeal space and posterior mediastinum were performed.
• The patient demonstrated a significant clinical recovery post-operatively.
• Histopathological examination confirmed descending necrotizing mediastinitis.

Implications:

• Timely diagnosis and surgical intervention, specifically transcervical drainage, are critical for managing DNM.
• Aggressive monitoring including clinical assessment, CT imaging, and laboratory tests is essential for early detection and management.
• While transcervical drainage is effective, transthoracic approaches may be necessary in refractory cases.