DESCENDING NECROTIZING MEDIASTINITIS - TH E IMPORTANCE OF EARLY DIAGNOSIS

BACKGROUND: Acute descending posterior mediastinitis is a very serious condition which can develop after common ear-nose throat infections. Clinical manifestations are typical and must be recognized rapidly for early diagnosis. CASE REPORTS: We report two cases. In the first case , a 28-year-old man had a retropharyngeal abscess which fistulized int o the left pleural cavity. Three operations were necessary to achieve cure and favorable outcome. In the second case, mediastinitis was diag nosed in a 39-year-old patient following a throat infection. Despite e arly surgery, outcome was fatal due to develop ment of pericarditis an d tamponnade. DISCUSSION: These two cases illustrate the variable cour se of descending mediastinitis and emphasize the importance of early m edicosurgical cure. Treatment is based on intravenous antibiotics usin g a combination of 2 or 3 drugs at high doses in association with emer gency surgery and extensive mediastinal washings. Despite well-conduct ed treatment, descending necrotizing mediastinitis may lead to a fatal outcome. (C) 1998, Masson, Paris.