RAPPORT DE CAS Acute Mediastinitis as a Complication of Epstein-Barr Virus (original) (raw)
Related papers
Acute Mediastinitis as a Complication of Epstein-Barr Virus
CJEM, 2015
Acute mediastinitis is a rare, potentially life-threatening condition that is most commonly seen as a complication of esophageal perforations or cardiac surgery. The term “descending necrotizing mediastinitis” (DNM) is used to describe oropharyngeal infections that spread to the mediastinum, most commonly following odontogenic infections, peritonsillar or retropharyngeal abscesses, cervical lymphadenitis, trauma, or endotracheal intubation. Infectious mononucleosis is another rare cause of DNM. The mortality of acute mediastinitis is high, while the mortality for DNM is even higher. Major determinants of mortality are delayed diagnosis and/or treatment. While DNM is seen infrequently, its severe nature makes it essential that emergency physicians consider the diagnosis in patients presenting with upper respiratory infections, chest pain, and systemic symptoms, and also in patients with a recent diagnosis of EBV, in order to mitigate a high rate of morbidity and mortality.
BMJ case reports, 2018
Descending necrotising mediastinitis (DNM) is an uncommon clinical entity which may arise secondary to primary odontogenic or neck infection in susceptible patients. Infection may spread contiguously via the alar or 'danger' space, a potential anatomical space posterior to the true retropharyngeal space. Spread of infection to the mediastinum almost always necessitates urgent cardiothoracic surgical intervention. This case report describes a male patient whose clinical deterioration following the diagnosis of submandibular abscess was investigated with CT imaging of the chest, where a diagnosis of DNM was made. Diagnosis was confirmed following surgical intervention and aspiration of pus from the mediastinum.
Unusual case of exacerbation of sub-acute descending necrotizing mediastinitis
Descending necrotizing mediastinitis is a life-threatening complication of an oropharyngeal infection that requires prompt and aggressive medical and surgical therapy. Herein, we report unusual case of man suffering of sub-acute mediastinal infection due to odontoiatric abscess which exacerbated at 3 months after its first presentation. Chest X-ray and CT scan demonstrated soft-tissue swelling of the neck and encapsulated fluid collections with gas bubbles within anterior mediastinum, especially on the right side. Bilateral anterior neck dissections were performed and blunt dissection, irrigation and debridement were carried out to several centimetres below the sternal manubrium. Then, right standard thoracotomy was performed with debridement of the anterior mediastinum. Four tubes were placed in the mediastinum and pleural cavity on the right side, and two tubes were placed in the left thoracic cavity. Follow-up CT scans of neck and chest showed the resolution of infection.
SMALL SERIES OF MEDIASTINITIS CASES ASSISTED AT THE LOURENÇO JORGE DE HOSPITAL MUNICIPAL IN THE LAST 3 YEARS (Atena Editora), 2022
Acute mediastinitis is a severe infection of the connective tissue that fills the mediastinal interpleural space and surrounds the mid-thoracic organs. It has, as one of its most serious and often lethal presentations, descending necrotizing mediastinitis (DMN), which is due to the descending dissemination of deep neck infections, infections that can arise as a complication of “banal” odontogenic, pharyngeal and cervicofacial foci”, not including translocation of infection from non-cervical mediastinal regions (lungs, ribs...). It is noteworthy that esophageal perforation and postoperative infections after sternotomy incisions in patients undergoing cardiac surgery more often result in isolated mediastinal abscesses, not being considered MND.
Descending Necrotising Mediastinitis, A Fatal Disease to Keep in Mind
Heart, Lung and Circulation, 2010
Descending necrotising mediastinitis, a term used by [1], is a rare and serious disease requiring prompt diagnosis and immediate aggressive surgical therapy. It should be considered in the differential diagnosis of acute mediastinal widening. We report an unusual case of primary retropharyngeal abscess complicated by descending necrotising mediastinitis and bilateral empyema in a 56-year-old diabetic man. The diagnosis of descending necrotising mediastinitis (DNM) was established by the characteristic findings on computed tomography. The patient was treated by cervicotomy and staged bilateral posterolateral thoracotomy.
Descending necrotizing mediastinitis: increased mortality due to delayed presentation
Turkish Journal of Medical Sciences, 2012
Aim: To describe the clinical features of descending necrotizing mediastinitis (DNM) and to outline the diagnostic and therapeutic measures to be taken in its management. Materials and methods: We retrospectively analyzed the data from 13 patients with DNM treated between 2001 and 2012 in 2 tertiary care centers, together with their demographics, diagnostic methods, therapeutic interventions, and clinical outcomes. Results: The patients consisted of 10 males and 3 females, aged from 16 to 72 years (mean age: 44). Odontogenic and tonsillar infections were the probable sources of infection in the majority of cases. Computerized tomography is a crucial imaging modality in the diagnosis and follow-up of patients with DNM. All patients underwent surgical treatment in addition to intravenous broad-spectrum antibiotics. Tube thoracostomy, mediastinal drainage, cervical drainage, and thoracotomy were the therapeutic measures utilized in these patients. Five patients were lost (38%) and 8 survived. Conclusion: DNM is a life-threatening condition that may originate from oropharyngeal infections. Emergency surgical intervention is mandatory in the management of DNM. The 2 most important survival factors are early surgical intervention and adequate drainage.
Descending Necrotizing Mediastinitis due to Odontogenic Infection: An unusual Case Report
. The aim of this paper is to report the case of a young male patient affected by an odontogenic infection with severe systemic complications. Case Report A 21-year-old normossemic patient sought care in an emergency hospital with a major complaint of neck swelling and pain to breathe, talk, eat and drink water, presenting anodontogenic infection of the lower right first molar tooth that evolved for 9 days with no previous medical assistance. The clinical aspect showed (Figure 1) redness and extensive swelling of hardened consistency of neck, submandibular, submental and sublingual spaces bilaterally, trismus, dysphasia, dyspnea, dehydration, speech alteration and limited cervical mobilization. The diagnostic hypothesis was deep cervical infection and descending mediastinitis arising from Ludwig's Angina at the expense of a dental infection source. Due to the clinical characteristics presented, complementary exams were requested for diagnostic assistance: chest, neck and face CTs, complete blood count, hemoculture, antibiogram, renal function markers and rapid HIV test (as the request of the patient). The initial thorax CT (Figure 2) evidenced a considerable increase in the mediastinal planes, with inflammatory areas in the upper and anterior compartments, pleural and pericardial effusion with mediastinal lymph nodes with altered and reactional appearance. The initial cervical CT (Figure 3) showed multiple fluid collections with gaseous foci in the left, parapharyngeal, anterior cervical, right lateral, retropharyngeal and submandibular spaces, with communication between them and a determined extensive mucosal bulging and reduction of the oropharyngeal space. Densification of the muscular planes and glottic region with extensive edema in the visceral space were visualized, characterizing a diffuse and extensive inflammatory process in the cervical region. The patient did not present seropositivity for the HIV virus, exhibited laboratorial values compatible with normal renal function, blood current mixed microbiota with the predominance of Staphyloccuscapitis and sensitivity to all the antibiotics tested, ruling out the presence of super-resistant bacteria. The initial hemogram showed an increased marked number of leukocytes and neutrophils, suggesting a recently established infectious and inflammatory condition. As soon as the diagnostic had been confirmed it was opted for early surgical intervention. The procedures consisted of thoracotomy with the objective of managing pericardial and pleural effusions (Figure 4) to avoid the patient's septic shock; surgical drainage of the right cervical, sublingual, left submandibular, left buccal spaces was also performed plus the extraction of the compromised tooth (Figure 5), indicated as the etiological factor. No airway management surgical procedure was performed. For complete drainage, Penrose and chest drains were installed, which were maintained for 3 and 7 days, respectively.
Optimal treatment of descending necrotising mediastinitis
Thorax, 1997
fections. In the post-antibiotic era this complication of neck infection is much less Background -Descending necrotising mediastinitis is caused by downward common. Estrera et al 2 reported the largest series since 1960 with 10 cases. We have suc-spread of neck infection and has a high fatality rate of 31%. The seriousness of cessfully treated seven adult patients with descending necrotising mediastinitis and also this infection is caused by the absence of barriers in the contiguous fascial planes present a child in whom the infection developed and spread rapidly, leading to death. This paper of neck and mediastinum. Methods -The recent successful treatment reviews these cases and presents a meta-analysis of 24 case reports and 12 series of adult des-of seven adult patients with descending necrotising mediastinitis emphasises the cending necrotising mediastinitis since 1970. importance of optimal early drainage of both neck and mediastinum and prolonged antibiotic therapy. The case is also pre-Methods sented of a child with descending ne- 1 crotising mediastinitis, demonstrating the A 35 year old male engineer with a past history rapidity with which the infection can deof hepatitis B was admitted following transfer velop and lead to death. Twenty four case from the intensive care unit of a peripheral reports and 12 series of adult patients with hospital. Five days prior to admission he had descending necrotising mediastinitis pubsought medical attention for odynophagia, lished since 1970 were reviewed with metahoarseness, and mild left otalgia for which he analysis. In each case of confirmed deswas given oral penicillin. Forty eight hours later cending necrotising mediastinitis the he was admitted to the intensive care unit Department of method of surgical drainage (cervical, me-Otolaryngology with bilateral pleuritic chest pain, fever, chills, diastinal, or none) and the survival out-M J Corsten progressive shortness of breath, and confusion. P F Odell come (discharge home or death) were He was given intravenous penicillin and cefo-G G Laframboise noted. The 2 test of statistical significance taxime, but his condition worsened and rewas used to detect a difference between Division of Thoracic quired transfer to Ottawa within 24 hours. Surgery cases treated with cervical drainage alone Admission radiographs including a com-F M Shamji and cases where mediastinal drainage was K R Reid puted tomographic (CT) scan demonstrated added. E Vallieres left retropharyngeal gas and inflammatory Results -Cervical drainage alone was changes, with extension via the fascial planes Department of often insufficient to control the infection of the neck to the mediastinum (fig 1A and B). Radiological Sciences with a fatality rate of 47% compared with F Matzinger