DESCENDING NECROTIZING MEDIASTINITIS SECONDARY TO A RETROPHARYNGEAL ABSCESS

A rare case of descending necrotizing mediastinitis (DNM) secondary to a nontraumatic retropharyngeal abscess is reported. Even in the era o f antibiotics, the mortality of DNM is still around 40%. In spite of d rainage of a localized neck abscess, and the administration of systemi c antibiotics, the retropharyngeal abscess extended to the pericardial and pleural cavities. Several drainage procedures and thoracotomies w ere performed to treat the bilateral empyemas and purulent pericarditi s. The patient was discharged on hospital day 52. Computed tomography was used to follow the progression of disease, and assess the efficacy of treatment. DNM is a very aggressive form of mediastinitis. The imp ortance of proper mediastinal drainage, as well as the systemic admini stration of antibiotics, must be emphasized.