Descending necrotizing mediastinitis in an infant

Descending necrotising mediastinitis: a rare entity in children

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.

Confluent Retropharyngeal, Lateral Pharyngeal, and Peritonsilar MRSA Abscess in an Infant

Neck abscesses such as retropharyngeal, peritonsilar, and lateral pharyngeal are well described, typically cause a characteristic illness, and have a known epidemiology. We present a rare occurrence of case of confluent, mixed retropharyngeal, lateral pharyngeal, and peritonsilar abscess in a 9-month-old female infant. The symptoms at presentation were very mild and not expected in association with this extensive an abscess. The causative organism was methicillin-resistant Staphylococcus aureus.

Management of descending necrotizing mediastinitis complicated with empyema by video-assisted thoracoscopic surgery

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.