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Leonardi B, Natale G, Sagnelli C, Marella A, Leone F, Capasso F, Giorgiano NM, Pica DG, Mirra R, Di Filippo V, Messina G, Vicidomini G, Motta G, Massimilla EA, Motta G, Rendina EA, Peritone V, Andreetti C, Fiorelli A, Sica A. Multidisciplinary Management of Descending Necrotizing Mediastinitis: Is Thoracoscopic Treatment Feasible? J Clin Med 2024; 13:2440. [PMID: 38673713 PMCID: PMC11051203 DOI: 10.3390/jcm13082440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/06/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Descending necrotizing mediastinitis (DNM) is a life-threatening condition, generally caused by downward dissemination of oropharyngeal infections through cervical fascial planes. Mediastinal drainage is conventionally achieved by thoracotomy, but a Video-Assisted Thoracoscopic Surgery (VATS) approach is gaining interest due to the reduced invasiveness of procedure. We aimed to evaluate the effectiveness of VATS treatment in patients with DNM. Methods: We conducted a retrospective multicenter study including patients with descending mediastinitis that underwent mediastinal drainage through VATS (VATS group) or thoracotomy (thoracotomy group), both in association with cervical drainage. Patients with mediastinitis secondary to cardiac, pulmonary, or esophageal surgery were excluded. The intergroup differences regarding surgical outcome and postoperative morbidity and mortality were compared. Results: A total of 21 patients were treated for descending mediastinitis during the study period. Cervicotomy and thoracotomy were performed in 15 patients (71%), while cervicotomy and VATS were performed in 6 patients (29%). There were no significant differences in surgical outcome, postoperative morbidity, and mortality between groups. VATS treatment was not associated with a higher complication rate. Patients in the VATS group had a shorter operative time (p = 0.016) and shorter ICU stay (p = 0.026). Conclusions: VATS treatment of DNM is safe and effective. The comparison with thoracotomy showed no significant differences in postoperative morbidity and mortality. The VATS approach is associated with a shorter operative time and ICU stay than thoracotomy.
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Affiliation(s)
- Beatrice Leonardi
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (G.N.); (A.M.); (F.L.); (F.C.); (N.M.G.); (D.G.P.); (R.M.); (V.D.F.); (G.M.); (G.V.); (A.F.)
| | - Giovanni Natale
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (G.N.); (A.M.); (F.L.); (F.C.); (N.M.G.); (D.G.P.); (R.M.); (V.D.F.); (G.M.); (G.V.); (A.F.)
| | - Caterina Sagnelli
- Department of Mental Health and Public Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Antonio Marella
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (G.N.); (A.M.); (F.L.); (F.C.); (N.M.G.); (D.G.P.); (R.M.); (V.D.F.); (G.M.); (G.V.); (A.F.)
| | - Francesco Leone
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (G.N.); (A.M.); (F.L.); (F.C.); (N.M.G.); (D.G.P.); (R.M.); (V.D.F.); (G.M.); (G.V.); (A.F.)
| | - Francesca Capasso
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (G.N.); (A.M.); (F.L.); (F.C.); (N.M.G.); (D.G.P.); (R.M.); (V.D.F.); (G.M.); (G.V.); (A.F.)
| | - Noemi Maria Giorgiano
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (G.N.); (A.M.); (F.L.); (F.C.); (N.M.G.); (D.G.P.); (R.M.); (V.D.F.); (G.M.); (G.V.); (A.F.)
| | - Davide Gerardo Pica
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (G.N.); (A.M.); (F.L.); (F.C.); (N.M.G.); (D.G.P.); (R.M.); (V.D.F.); (G.M.); (G.V.); (A.F.)
| | - Rosa Mirra
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (G.N.); (A.M.); (F.L.); (F.C.); (N.M.G.); (D.G.P.); (R.M.); (V.D.F.); (G.M.); (G.V.); (A.F.)
| | - Vincenzo Di Filippo
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (G.N.); (A.M.); (F.L.); (F.C.); (N.M.G.); (D.G.P.); (R.M.); (V.D.F.); (G.M.); (G.V.); (A.F.)
| | - Gaetana Messina
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (G.N.); (A.M.); (F.L.); (F.C.); (N.M.G.); (D.G.P.); (R.M.); (V.D.F.); (G.M.); (G.V.); (A.F.)
| | - Giovanni Vicidomini
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (G.N.); (A.M.); (F.L.); (F.C.); (N.M.G.); (D.G.P.); (R.M.); (V.D.F.); (G.M.); (G.V.); (A.F.)
| | - Giovanni Motta
- Head and Neck Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (G.M.); (E.A.M.); (G.M.)
| | - Eva Aurora Massimilla
- Head and Neck Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (G.M.); (E.A.M.); (G.M.)
| | - Gaetano Motta
- Head and Neck Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (G.M.); (E.A.M.); (G.M.)
| | - Erino Angelo Rendina
- Thoracic Surgery Unit, Sant’Andrea Hospital, Sapienza University, 00185 Rome, Italy; (E.A.R.); (V.P.); (C.A.)
| | - Valentina Peritone
- Thoracic Surgery Unit, Sant’Andrea Hospital, Sapienza University, 00185 Rome, Italy; (E.A.R.); (V.P.); (C.A.)
| | - Claudio Andreetti
- Thoracic Surgery Unit, Sant’Andrea Hospital, Sapienza University, 00185 Rome, Italy; (E.A.R.); (V.P.); (C.A.)
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (G.N.); (A.M.); (F.L.); (F.C.); (N.M.G.); (D.G.P.); (R.M.); (V.D.F.); (G.M.); (G.V.); (A.F.)
| | - Antonello Sica
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy;
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Jung YJ, Park JI. Mimicking descending necrotizing mediastinitis as acute myocardial infarction in a patient with severe coronary artery disease: A case report. Medicine (Baltimore) 2023; 102:e36571. [PMID: 38065879 PMCID: PMC10713176 DOI: 10.1097/md.0000000000036571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
RATIONALE It is a crucial disease that descending necrotizing mediastinitis need to be treated promptly with proper antibiotics and drainage. The characteristics of its symptoms such as chest pain are difficult to distinguish from acute myocardial infarction. PATIENT CONCERNS An 80-year-old female presented with severe squeezing chest pain. The cardiac marker was elevated. And coronary angiography showed the significant coronary stenosis. Although the revascularization through percutaneous coronary intervention was completed successfully, the patient still presented chest pain. Computed tomography of neck revealed that hypodense heterogeneous lesions with clear and distinguishable margin extended from the deep neck to mediastinum diffusely. DIAGNOSES The patient was diagnosed with descending necrotizing mediastinitis. INTERVENTIONS Percutaneous catheter insertion to patient's abscess lesion at was performed. OUTCOMES Catheter drainage of descending necrotizing mediastinitis led to an improvement in the patient's condition. LESSON Descending necrotizing mediastinitis made chest paint with elevated cardiac enzyme mimicked myocardial infarction.
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Affiliation(s)
- Yu Jung Jung
- Division of Cardiology, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Jong-Il Park
- Division of Cardiology, Yeungnam University Medical Center, Daegu, Republic of Korea
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Chen SL, Chin SC, Chan KC, Ho CY. A Machine Learning Approach to Assess Patients with Deep Neck Infection Progression to Descending Mediastinitis: Preliminary Results. Diagnostics (Basel) 2023; 13:2736. [PMID: 37685275 PMCID: PMC10486957 DOI: 10.3390/diagnostics13172736] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/25/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Deep neck infection (DNI) is a serious infectious disease, and descending mediastinitis is a fatal infection of the mediastinum. However, no study has applied artificial intelligence to assess progression to descending mediastinitis in DNI patients. Thus, we developed a model to assess the possible progression of DNI to descending mediastinitis. METHODS Between August 2017 and December 2022, 380 patients with DNI were enrolled; 75% of patients (n = 285) were assigned to the training group for validation, whereas the remaining 25% (n = 95) were assigned to the test group to determine the accuracy. The patients' clinical and computed tomography (CT) parameters were analyzed via the k-nearest neighbor method. The predicted and actual progression of DNI patients to descending mediastinitis were compared. RESULTS In the training and test groups, there was no statistical significance (all p > 0.05) noted at clinical variables (age, gender, chief complaint period, white blood cells, C-reactive protein, diabetes mellitus, and blood sugar), deep neck space (parapharyngeal, submandibular, retropharyngeal, and multiple spaces involved, ≥3), tracheostomy performance, imaging parameters (maximum diameter of abscess and nearest distance from abscess to level of sternum notch), or progression to mediastinitis. The model had a predictive accuracy of 82.11% (78/95 patients), with sensitivity and specificity of 41.67% and 87.95%, respectively. CONCLUSIONS Our model can assess the progression of DNI to descending mediastinitis depending on clinical and imaging parameters. It can be used to identify DNI patients who will benefit from prompt treatment.
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Affiliation(s)
- Shih-Lung Chen
- Department of Otorhinolaryngology & Head and Neck Surgery, Chang Gung Memorial Hospital, New Taipei City 333, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Shy-Chyi Chin
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, New Taipei City 333, Taiwan
| | - Kai-Chieh Chan
- Department of Otorhinolaryngology & Head and Neck Surgery, Chang Gung Memorial Hospital, New Taipei City 333, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Chia-Ying Ho
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
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