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Descending cervical mediastinitis
P D Kiernan1, A Hernandez, W D Byrne
1Section of Thoracic Surgery, INOVA Health Systems, Annandale, Virginia, USA.
Abstract:
Descending cervical mediastinitis is an uncommonly reported presentation of infection originating in the head or neck and descending into the mediastinum, which is fraught with impressive morbidity and mortality rates of 30% to 40% or more. We present the INOVA-Fairfax-Alexandria Hospital experience with descending cervical mediastinitis, January 1, 1986, to April 1, 1997; in addition we review the English-language medical and surgical literature with regard to this entity. Computed tomography and magnetic resonance imaging serve to aid both diagnosis and management. The application of broad-spectrum antibiotics should initially be empiric, with an eye to coverage of mixed aerobic and anaerobic infections. Definitive treatment mandates early and aggressive surgical intervention. All affected tissue planes, cervical and mediastinal, must be widely debrided, often leaving them open for frequent packing and irrigation. The treating physician must remain always alert to the further extension of infection, which, if it occurs, must be further debrided and drained. Tracheostomy serves a dual role of further opening cervical fascial planes and securing an often compromised airway.
Insights
Descending cervical mediastinitis, a serious head/neck infection, has high mortality. Early surgical debridement and broad-spectrum antibiotics are crucial for managing this severe condition.
Area of Science:
- Infectious Diseases
- Surgical Pathology
- Medical Imaging
Background:
- Descending cervical mediastinitis is a rare but severe infection originating in the head or neck.
- It is associated with high morbidity and mortality rates, often exceeding 30-40%.
Observation:
- This study reviews the experience at INOVA-Fairfax-Alexandria Hospital from 1986-1997.
- It also includes a review of English-language literature on the subject.
- Computed tomography (CT) and magnetic resonance imaging (MRI) are valuable diagnostic and management tools.
Findings:
- Empiric broad-spectrum antibiotics are recommended for mixed aerobic and anaerobic infections.
- Early and aggressive surgical intervention is essential for definitive treatment.
- Wide debridement of infected cervical and mediastinal tissue planes is necessary, often requiring open packing and irrigation.
- Vigilance for further infection extension and prompt re-debridement/drainage are critical.
- Tracheostomy can aid in opening cervical planes and securing the airway.
Implications:
- Prompt diagnosis and aggressive multimodal treatment, including surgery and antibiotics, can improve outcomes.
- Effective management requires a coordinated approach involving medical and surgical teams.
- Understanding the role of advanced imaging is vital for diagnosis and monitoring treatment effectiveness.