[A case of acute idiopathic mediastinitis that responded rapidly to treatment]

A 50-year-old man had a feeling of a foreign substance such as fish bone in his throat at breakfast. The feeling gradually changed to retrosternal pain and pain on swallowing, so he went to hospital, but the results of all examinations were normal. The next day he was referred to our emergency center because of the increasing pain and disturbance in swallowing. On admission he had a fever of 37.9 degrees C, a WBC of 35,000 cells/mm3, and a CRP level of 18.3 mg/dl. There was no widening of the mediastinum visible on the chest radiograph, but on the chest CT a tumorous shadow was seen around the esophagus from the cervical to the gastric portion, and was suspected to be an abscess. Some antibiotics were given, based on the diagnosis of acute mediastinitis. The pain gradually subsided, and the tumorous shadow was obscured, without mediastinal drainage. Prompt therapy resulted in rapid improvement, and the patient was discharged on hospital day 23.