ST-Segment Elevation Beyond the Coronaries: A Case of Necrotizing Mediastinitis
Related Experiment Videos
Swapna Sarangi1, Skylar Murphy1, Kyle Coombes1
1Department of Internal Medicine, University of Illinois College of Medicine, Peoria, Illinois, USA.
Background:
Descending necrotizing mediastinitis (DNM) is a rare, life-threatening infection (mortality 18%-36%) that can extend to the pericardium and produce electrocardiogram changes mimicking ST-segmentelevation myocardial infarction (STEMI).
Case Summary:
A young, previously healthy man presented with anterior chest pain. Initial electrocardiogram showed ST-segment elevation prompting STEMI suspicion. Computed tomography angiography of the chest revealed deep neck infection with mediastinal and pericardial extension, diagnosing DNM. Cultures grew Streptococcus constellatus. Management included broad-spectrum intravenous antibiotics and surgical drainage/debridement with intensive care unit care; the patient recovered.
Discussion:
DNM arises from oropharyngeal or odontogenic infection spreading along cervical fascial planes, with mortality driven by diagnostic delay and inadequate source control. S constellatus is an uncommon cause. This case highlights pericardial involvement as a noncoronary cause of ST elevation.
Take-Home Message:
Consider noncoronary causes of ST-segment elevation; early imaging is essential to diagnose DNM and guide lifesaving source control.
Related Concept Videos
Acute Coronary Syndrome I: Introduction
Esophageal Perforation-II: Clinical Manifestations and Management
Clinical Manifestations:
Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
Myocarditis I: Introduction
Esophageal Perforation-I: Introduction
The location of esophageal perforation can vary, occurring anywhere along the esophagus.
Atelectasis II: Pathophysiology