DESCENDING NECROTIZING MEDIASTINITIS CAUSING PLEUROESOPHAGEAL FISTULA- SUCCESSFUL TREATMENT BY COMBINED TRANSCERVICAL AND PLEURAL DRAINAGE

Descending necrotizing mediastinitis (DNM) develops as a complication of an oropharyngeal infection and can be life-threatening. Aggressive therapy is generally advised; usually, treatment consists of cervicome diastinal and transthoracic drainage combined with broad-spectrum anti microbial therapy, especially when the necrotizing process extends bel ow the level of the fourth thoracic vertebra. A rare case of DNM secon dary to a retropharyngeal abscess with fistula to both pleural cavitie s and to the hypopharynx is reported. The patient was successfully tre ated by cervicomediastinal surgical drainage and percutaneous drainage of both pleural cavities. In our opinion, even complicated DNM can be treated without aggressive surgery if the patient is in good conditio n.