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Marques DL, Rato C, Miguéis A, Miguéis J. Descending necrotising mediastinitis: a rare entity in children. BMJ Case Rep 2024; 17:e258304. [PMID: 38453221 PMCID: PMC10921524 DOI: 10.1136/bcr-2023-258304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
We present a case of descending necrotising mediastinitis (DNM) originating from a retropharyngeal abscess in a healthy early childhood patient. The patient had a history of fever, odynophagia and refusal to eat, followed by rapid deterioration of the clinical state. Cervicothoracic CT was performed, which revealed a right parapharyngeal abscess, extending to the mediastinum and occupying the retropharyngeal/visceral space, with gaseous content throughout this collection, associated with bilateral pleural effusion, aspects compatible with DNM. She started broad-spectrum antibiotic therapy and transoral drainage of the parapharyngeal and retropharyngeal collections was performed under general anaesthesia. She was admitted to the intensive care unit. The patient showed clinical, analytical and imaging improvement, having been transferred to the ear, nose and throat department, with favourable evolution. Early diagnosis of DNM by cervicothoracic CT and multidisciplinary approaches, including intensive care, broad-spectrum antibiotics and surgical intervention, are crucial to minimise the morbidity and mortality.
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Affiliation(s)
| | - Catarina Rato
- Department of Otorhinolaryngology, Coimbra University Hospital Centre, Coimbra, Portugal
| | - António Miguéis
- Department of Otorhinolaryngology, Coimbra University Hospital Centre, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Jorge Miguéis
- Department of Otorhinolaryngology, Coimbra University Hospital Centre, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Yoshimura M, Daifu T, Suehiro M, Shoji T, Higuchi Y. Descending Necrotizing Mediastinitis Caused by Streptococcus pyogenes in a Child with Primary Epstein-Barr Virus Infection. Pediatr Rep 2022; 15:16-19. [PMID: 36649003 PMCID: PMC9844267 DOI: 10.3390/pediatric15010003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/08/2022] [Accepted: 12/20/2022] [Indexed: 12/29/2022] Open
Abstract
Descending necrotizing mediastinitis (DNM) is a severe, life-threatening disease with a high mortality rate resulting from sepsis or other complications. DNM can also be a rare and severe complication of Epstein-Barr virus (EBV) infection in adolescents and young adults but has never been reported in a pre-school child. A 4-year-old girl was admitted to our hospital with a 2-day history of fever and chest pain. Computed tomography (CT) revealed a right sided pleural effusion, fluid collection in the retropharyngeal and mediastinal areas, cervical lymphadenopathy, and marked hepatosplenomegaly. She was diagnosed with empyema, retropharyngeal abscess, and mediastinitis. To improve her dyspnea, a chest tube was inserted, and antibiotic treatment was initiated. Her condition improved temporarily, but on day 5 in our hospital, she developed a fever again. A repeat CT scan showed exacerbation of fluid retention in the retropharyngeal area and the mediastinum, for which she underwent drainage and debridement of necrotic tissue in the retropharynx and mediastinum. The presence of cervical lymphadenopathy and marked hepatosplenomegaly suggested the involvement of EBV. Serological tests for EBV revealed primary EBV infection at the time of the DNM onset. Finally, she was diagnosed with DNM following primary EBV infection. At follow-up 1 year later, she was doing well. The risk of DNM should be recognized in patients, even pre-school aged children, with primary EBV infection.
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Affiliation(s)
- Miki Yoshimura
- Department of Pediatrics, Otsu Red Cross Hospital, Otsu 520-8511, Japan
| | - Tomoo Daifu
- Department of Pediatrics, Otsu Red Cross Hospital, Otsu 520-8511, Japan
- Correspondence: ; Tel.: +81-77-522-4131
| | - Minoru Suehiro
- Department of Pediatrics, Otsu Red Cross Hospital, Otsu 520-8511, Japan
| | - Tsuyoshi Shoji
- Department of Thoracic Surgery, Otsu Red Cross Hospital, Otsu 520-8511, Japan
| | - Yoshihisa Higuchi
- Department of Pediatrics, Otsu Red Cross Hospital, Otsu 520-8511, Japan
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Hasjim BJ, Ostowari A, Holmes WN, Yu Y, Yu P, Reyna T, Bhatt J, Awan S, Goodman LF. Methicillin-resistant staphylococcus aureus descending necrotizing mediastinitis in an infant. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Zhang Y, Wang W, Xin X, Jin Y, Liu W, Du G, Guo F. Management of descending necrotizing mediastinitis with severe thoracic empyema using minimally invasive video-assisted thoracoscopic surgery: a case report. Transl Pediatr 2022; 11:1415-1421. [PMID: 36072533 PMCID: PMC9442202 DOI: 10.21037/tp-22-60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 07/05/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Descending necrotizing mediastinitis (DNM) is a rare but serious complication of odontogenic or pharyngeal infection spreading into the mediastinum. Very few childhood cases of DNM have been described. CASE DESCRIPTION We report a case of DNM complicated with severe thoracic empyema in a previously healthy 6-year-old girl who was successfully treated using minimally invasive video-assisted thoracoscopic surgery (VATS). The patient presented with odynophagia and dental pain, followed by rapid clinical deterioration including high fever, tachypnea, and left chest pain. As chest computed tomography (CT) revealed features of DNM, she was transferred from the local hospital to our hospital for intensive care. Empirical treatment was started with meropenem and linezolid. However, her tachypnea and dyspnea progressed rapidly. An ultrasound-guided left-sided thoracentesis drained 80 mL of brown sticky pus and the pus culture yielded Streptococcus constellatus. A contrast-enhanced CT scan demonstrated large mediastinal abscess and severe thoracic empyema. We performed debridement and drainage of the mediastinum and pleura using VATS. She recovered and was discharged on hospital day 18. CONCLUSIONS Early diagnosis by cervicothoracic CT and multidisciplinary approaches including intensive care, broad-spectrum antibiotics, and aggressive surgical intervention are crucial to reducing morbidity and mortality. VATS is a minimally invasive and appropriate treatment strategy for children with DNM, especially complicated with thoracic empyema.
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Affiliation(s)
- Yongfei Zhang
- Department of Dermatology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Wei Wang
- Pediatric Critical Care Unit, Children's Hospital, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xiaowei Xin
- Pediatric Critical Care Unit, Children's Hospital, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Youpeng Jin
- Pediatric Critical Care Unit, Children's Hospital, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Wei Liu
- Department of Pediatric Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Guoqiang Du
- Department of Pediatric Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Feng Guo
- Department of Pediatric Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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Menéndez Del Castro M, Coca-Pelaz A, Menéndez S, Vivanco-Allende A, Pedregal-Mallo D, García-Cabo P, Fernández-Vañes L, Llorente JL. Retropharyngeal abscess and mediastinitis as an uncommon complication of varicella infection. Int J Pediatr Otorhinolaryngol 2020; 132:109904. [PMID: 32018164 DOI: 10.1016/j.ijporl.2020.109904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 01/21/2020] [Accepted: 01/21/2020] [Indexed: 10/25/2022]
Abstract
Varicella infection is one of the most common and contagious infection in children and could course with severe complications. We report the case of a 4-year-old patient derived to our hospital for suspicion of suppurative complication in the context of a varicella infection. A computerized tomographic scanning was performed, showing a large retropharyngeal abscess with mediastinitis. Complications of varicella are up to 2% of patients, but this is the first report of a retropharyngeal and mediastinal abscess in this context. In the face of clinical suspicion, early intervention is important through imaging, intravenous antibiotics and surgical drainage in necessary cases.
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Affiliation(s)
| | - Andrés Coca-Pelaz
- Department of Otolaryngology. Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturia, IUOPA, Oviedo, Spain
| | - Sergio Menéndez
- Pediatric Intensive Care Unit, Department of Pediatrics. Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Ana Vivanco-Allende
- Pediatric Intensive Care Unit, Department of Pediatrics. Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Daniel Pedregal-Mallo
- Department of Otolaryngology. Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Patricia García-Cabo
- Department of Otolaryngology. Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Laura Fernández-Vañes
- Department of Otolaryngology. Hospital Universitario Central de Asturias, Oviedo, Spain
| | - José Luis Llorente
- Department of Otolaryngology. Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturia, IUOPA, Oviedo, Spain
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Chen IC, Hsu JH, Dai ZK. Management of descending necrotizing mediastinitis complicated with empyema by video-assisted thoracoscopic surgery. Pediatr Pulmonol 2016; 51:E17-20. [PMID: 26716737 DOI: 10.1002/ppul.23375] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 11/13/2015] [Accepted: 12/15/2015] [Indexed: 11/12/2022]
Abstract
Descending necrotizing mediastinitis (DNM) is an uncommon disease that can cause significant morbidity and mortality. Herein, we report a 17-month-old girl of DNM with an initial normal chest radiograph followed by rapid clinical deterioration during a period of 4 days, from deep neck infection to mediastinitis and then complicated empyema. She was managed successfully with intravenous antibiotics and surgical debridement by video-assisted thoracic surgery (VATS) and cervical drainage. Early recognition and meticulous intensive care of patients with DNM are important to minimize morbidity and mortality. VATS is an effective and minimally invasive therapeutic strategy in children with DNM.
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Affiliation(s)
- I-Chen Chen
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Jong-Hau Hsu
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Zen-Kong Dai
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Dajer-Fadel WL, Borrego-Borrego R, Flores-Calderon O, Ibarra-Perez C. Descending necrotizing mediastinitis and thoracic cellulitis due to varicella. Asian Cardiovasc Thorac Ann 2012; 20:83-5. [DOI: 10.1177/0218492311429615] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A 22-year-old man with varicella had associated cervical enlargement, right upper thoracic anterior and suprascapular cellulitis, and mediastinitis. A tracheostomy, right posterolateral thoracotomy, cervicotomy, and upper thoracic fasciotomy were performed 14 h after admission, draining purulent exudates from all sites. The patient was discharged on postoperative day 22.
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Affiliation(s)
- Walid L Dajer-Fadel
- Department of Cardiothoracic Surgery, General Hospital of Mexico, Mexico City, Mexico
| | | | | | - Carlos Ibarra-Perez
- Department of Cardiothoracic Surgery, General Hospital of Mexico, Mexico City, Mexico
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Adult varicella zoster infection complicated with streptococcal retrosternal abscess. South Med J 2011; 102:653-5. [PMID: 19434036 DOI: 10.1097/smj.0b013e3181a49a71] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 43-year-old lady with type 2 diabetes mellitus and bronchial asthma presented with varicella zoster infection, dyspnea, and neck fullness. An urgent computed tomography scan revealed a mediastinal abscess with superior vena cava thrombus. Blood, mediastinal pus, and swab from a vesiculopustule on the neck cultured group A beta hemolytic Streptococcus. She recovered with a combination of broad spectrum antimicrobials, antivirals, and surgical drainage. This case illustrates the rare occurrence of mediastinal abscess and acute superior vena cava obstruction caused by group A beta hemolytic Streptococcus complicating adult varicella zoster.
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Descending necrotizing mediastinitis secondary to retropharyngeal abscess in a child. J Infect Chemother 2008; 14:255-7. [PMID: 18574665 DOI: 10.1007/s10156-008-0606-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2007] [Accepted: 02/22/2008] [Indexed: 10/21/2022]
Abstract
We report herein of a 6-year-old boy with descending necrotizing mediastinitis (DNM) secondary to retropharyngeal abscess, who was successfully treated by the administration of antibiotics. DNM is very rare in children, and surgical drainage of the mediastinum is recommended in adult patients. DNM should be recognized as a severe complication of an oropharyngeal infection in children, and early and accurate diagnosis is important in ensuring appropriate clinical management.
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