Descending suppurative mediastinitis: Nonsurgical approach to this unusualcomplication of retropharyngeal abscesses in childhood

Objective: To alert the pediatric emergency physician about suppurative med iastinitis as an unusual, life-threatening complication of retropharyngeal abscesses in children and to report an alternative therapeutic option for t hese cases. Methods: We describe a case of suppurative mediastinitis secondary to a ret ropharyngeal abscess in a 19-month-old girl and discuss the pathophysiology , diagnosis, and treatment of this disease. Results: Prompt diagnosis, based on clinical, radiographic, and CT findings , followed by immediate retropharyngeal drainage and appropriate antibiotic therapy, allowed conservative management of the mediastinal abscess, witho ut the need for surgery. The child presented a good outcome and was dischar ged on hospital day 14. Conclusions: When evaluating a retropharyngeal abscess, the pediatric emerg ency physician should be aware of its complications. A chest radiograph sho uld be prescribed for each patient presenting with an indolent course. Wide ning of the mediastinum should be considered as strong evidence of a medias tinal abscess for which the best therapeutic option is aggressive surgical drainage. In the rare cases in which marked improvement is achieved after r etropharyngeal drainage, a nonsurgical approach to the mediastinal abscess could be attempted. CT scan and a simple chest radiograph have proved to be useful for diagnosis and follow-up.