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Sudden Death: A Practical Autopsy Approach to Unexplained Mediastinitis Due to Fatal Untreated Neck Infections-A
Aniello Maiese1, Fabio Del Duca2, Alessandro Ghamlouch2
1Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy.
Abstract:
Neck infections are often prone to being underestimated and can manifest insidiously. The spread of infection can lead to translocation into thoracic areas, causing descending necrotizing mediastinitis (DNM). However, the application of the post-mortem approach in such cases is not well-described in the literature. A literature review was carried out according to the PRISMA methods. Nine papers were included in the final review, revealing different levels of involvement of neck layers that can be linked to different causes. Expertise with respect to the anatomy of the fasciae and spaces of the neck enables an understanding of the pathogenesis of DNM. However, a clear autoptic description was not provided in any of the articles. Therefore, we also employed a practical post-mortem approach to cases of death due to DNM. It is fundamental for pathologists to identify the exact head and neck structures involved. Providing dissectors with support from an otolaryngologist could be useful. This paper could help address such difficult cases.
Insights
Descending necrotizing mediastinitis (DNM) is a severe complication of neck infections. This study reviews DNM cases and proposes a practical post-mortem approach for pathologists to identify head and neck structures involved in this condition.
Area of Science:
- Forensic Pathology
- Anatomy
- Infectious Diseases
Background:
- Neck infections can insidiously spread, leading to severe thoracic complications like descending necrotizing mediastinitis (DNM).
- The post-mortem examination of DNM cases is not well-documented in existing literature.
- Understanding neck fascial anatomy is crucial for comprehending DNM pathogenesis.
Purpose of the Study:
- To review the literature on descending necrotizing mediastinitis (DNM) and its association with neck infections.
- To describe a practical post-mortem approach for evaluating DNM cases.
- To highlight the importance of anatomical identification in forensic pathology of DNM.
Main Methods:
- A systematic literature review was conducted following PRISMA guidelines.
- Nine relevant papers were included in the final analysis.
- A practical post-mortem approach was developed and applied to DNM cases.
Main Results:
- The literature review revealed varied involvement of neck layers in DNM, linked to different etiologies.
- No articles provided a clear autoptic description of DNM pathogenesis.
- The proposed post-mortem approach aids in identifying specific head and neck structures involved in DNM.
Conclusions:
- Expertise in neck anatomy is essential for understanding DNM.
- A standardized post-mortem approach is needed for accurate assessment of DNM.
- Collaboration between pathologists and otolaryngologists can improve the evaluation of complex head and neck cases.
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