Thoracoscopic Management of Descending Necrotizing Mediastinitis

Descending necrotizing mediastinitis (DNM) is a lethal process originating from odontogenic, pharyngeal, or cervical infectious sources that descends along fascial planes into the mediastinum. Despite earlier use of antibiotics and surgical drainage, the mortality (>50%) has changed little since...

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Veröffentlicht in:Chest 1997-09, Vol.112 (3), p.850-854
Hauptverfasser: Roberts, John R., Smythe, W. Roy, Weber, Randall W., Lanutti, Michael, Rosengard, Bruce R., Kaiser, Larry R.
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Sprache:eng
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Zusammenfassung:Descending necrotizing mediastinitis (DNM) is a lethal process originating from odontogenic, pharyngeal, or cervical infectious sources that descends along fascial planes into the mediastinum. Despite earlier use of antibiotics and surgical drainage, the mortality (>50%) has changed little since the first large series reported in the preantibiotic era. The surgical management remains controversial, with support ranging from cervical drainage alone to cervical drainage and routine thoracotomy. We report a case of thoracoscopic drainage and debridement of a mediastinal abscess resulting from descending necrotizing mediastinitis. The decreased morbidity of this approach compared with posterolateral thoracotomy and the improved drainage of the mediastinum compared with cervical drainage support this method as an attractive management of patients with DNM.
ISSN:0012-3692
1931-3543
DOI:10.1378/chest.112.3.850