심경부 감염을 원인으로 발생한 하행 괴사성 종격동염의 임상적 영상학적 분석
Clinico-Radiographic Analysis of Descending Necrotizing Mediastinitis with Deep Neck Infection
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Background and Objectives: Early diagnosis and aggressive medical and surgical treatment are very important for successful prognosis of descending necrotizing mediastinitis (DNM), a rare and lethal complication of deep neck infections. Through a decade of retrospective study, we report our experience in early diagnosis and effective management of this devastating disease. Materials and Methods: We conducted a retrospective analysis of 14 DNM patients with odontogenic, oropharyngeal and retropharyngeal infections from March 2009 to March 2018. Data extracted from medical records of the patients included demographic, clinical characteristics and radiographic spreading pathway of DNM patients from deep neck space to mediastinum. Results: Fourteen patients were treated by otolaryngologic and cardiothoracic surgeons, three patients died as a result of septic shock and multiorgan failure with a mortality rate of 21.4%. Cervical pain and edema, which can be suspected of cervical infection, were present in most patients, but chest pain and dyspnea, which can be suspected of chest infection, were found in only one or two patients. Contrary to previous studies, the spreading pathway of infection via anterior cervical space to the mediastinum was also three times more common than that of retrovisceral space. Conclusions: Early diagnosis is the most important thing to treat fatal DNM. Although chest infection and retrovisceral space infection symptoms are not clear, it is essential to conduct early enhanced computed tomography including thorax in patients with deep neck infections.
Abstract
Background and Objectives: Early diagnosis and aggressive medical and surgical treatment are very important for successful prognosis of descending necrotizing mediastinitis (DNM), a rare and lethal complication of deep neck infections. Through a decade of retrospective study, we report our experience in early diagnosis and effective management of this devastating disease. Materials and Methods: We conducted a retrospective analysis of 14 DNM patients with odontogenic, oropharyngeal and retropharyngeal infections from March 2009 to March 2018. Data extracted from medical records of the patients included demographic, clinical characteristics and radiographic spreading pathway of DNM patients from deep neck space to mediastinum. Results: Fourteen patients were treated by otolaryngologic and cardiothoracic surgeons, three patients died as a result of septic shock and multiorgan failure with a mortality rate of 21.4%. Cervical pain and edema, which can be suspected of cervical infection, were present in most patients, but chest pain and dyspnea, which can be suspected of chest infection, were found in only one or two patients. Contrary to previous studies, the spreading pathway of infection via anterior cervical space to the mediastinum was also three times more common than that of retrovisceral space. Conclusions: Early diagnosis is the most important thing to treat fatal DNM. Although chest infection and retrovisceral space infection symptoms are not clear, it is essential to conduct early enhanced computed tomography including thorax in patients with deep neck infections.
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