1/16. Descending suppurative mediastinitis: nonsurgical approach to this unusual complication of retropharyngeal abscesses in childhood.OBJECTIVE: To alert the pediatric emergency physician about suppurative mediastinitis as an unusual, life-threatening complication of retropharyngeal abscesses in children and to report an alternative therapeutic option for these cases. methods: We describe a case of suppurative mediastinitis secondary to a retropharyngeal 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, without the need for surgery. The child presented a good outcome and was discharged on hospital day 14. CONCLUSIONS: When evaluating a retropharyngeal abscess, the pediatric emergency physician should be aware of its complications. A chest radiograph should be prescribed for each patient presenting with an indolent course. Widening of the mediastinum should be considered as strong evidence of a mediastinal abscess for which the best therapeutic option is aggressive surgical drainage. In the rare cases in which marked improvement is achieved after retropharyngeal 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.- - - - - - - - - - ranking = 1keywords = retropharyngeal abscess, retropharyngeal (Clic here for more details about this article) |
2/16. Cervical necrotizing fasciitis of odontogenic origin: a report of 11 cases.PURPOSE: Although most cases of cervical necrotizing fasciitis (CNF) are odontogenic in origin, reports of this disease in the dental literature are sparse. The purpose of this study was to review the cases treated on our service, and to analyze the features of this disease and the responses to management, to supplement the understanding of this relatively rare and life-threatening disease. patients AND methods: All cases of infection admitted to the OMS service in a period of 10.5 years were studied retrospectively. The diagnosis of CNF was established by the findings on surgical exploration and histologic examination. The patients' age, sex, medical status, causes of the infection, bacteriology, computed tomography scan findings, surgical interventions, complications, survival, and other clinical parameters were reviewed. RESULTS: A total of 422 cases of infection were admitted, and 11 cases of cervical necrotizing fasciitis were found. The incidence of CNF was 2.6% among the infections hospitalized on the OMS service. There were 7 male and 4 female patients. Eight patients were older than 60 years of age. Seven patients had immunocompromising conditions, including diabetes mellitus in 4, concurrent administration of steroid in 2, uremia in 1, and a thymus carcinoma in 1. All patients showed parapharyngeal space involvement; four also showed retropharyngeal space involvement. Gas was found in the computed tomography scan in 6 patients, extending to cranial base in 3 of them. Anaerobes were isolated in 73% of the infections, whereas streptococcus species were uniformly present. All patients received 1 or more debridements. Major complications occurred in 4 patients, including mediastinitis in 4, septic shock in 2, lung empyema in 1, pleural effusion in 2, and pericardial effusion in 1. All major complications developed in the immunocompromised patients, leading to 2 deaths. CONCLUSION: The mortality rate in this study was 18%. Early surgical debridement, intensive medical care, and a multidisciplinary approach are advocated in the management of CNF.- - - - - - - - - - ranking = 0.022398642064485keywords = retropharyngeal (Clic here for more details about this article) |
3/16. mediastinitis and retropharyngeal abscess following delayed diagnosis of glass ingestion.Foreign body ingestion is a common occurrence in childhood. We report the outcome of an infant who swallowed a piece of glass. The absence of a foreign body on chest radiograph led to delayed diagnosis and then to the well documented complications of retropharyngeal abscess and mediastinitis. She was admitted to the paediatric intensive care unit a week after her initial presentation, subjected to multiple invasive and non-invasive procedures, and 6 weeks after her initial presentation to the accident and emergency department, was discharged back to her referring hospital having re-established oral feeds.- - - - - - - - - - ranking = 0.68228765419359keywords = retropharyngeal abscess, retropharyngeal (Clic here for more details about this article) |
4/16. mediastinitis following nasal intubation in the emergency department.A patient who developed a retropharyngeal abscess and fatal mediastinitis following emergent nasal intubation is described. Despite aggressive surgical therapy the patient died of mediastinitis. Although mediastinitis as a complication of oral intubation has been described, mediastinitis following nasal intubation has not previously been reported.- - - - - - - - - - ranking = 0.13645753083872keywords = retropharyngeal abscess, retropharyngeal (Clic here for more details about this article) |
5/16. mediastinitis after whiplash injury.The authors describe a rare complication of whiplash injury. Diffuse mediastinitis resulted from extension of a whiplash-induced retropharyngeal abscess into the thorax. early diagnosis of the cervical infection was masked by the simultaneous presence of infectious mononucleosis. Aggressive surgical management including bilateral thoracotomy was required to resolve the septic course. A review of the literature discusses the pathogenesis of this complication including the route of extension into the mediastinum and supports the use of aggressive surgical therapy to reduce the associated mortality.- - - - - - - - - - ranking = 0.13645753083872keywords = retropharyngeal abscess, retropharyngeal (Clic here for more details about this article) |
6/16. Dissecting retropharyngeal abscess due to fusobacterium necrophorum in an adult.I have described an adult patient who had dissecting retropharyngeal abscess complicated by pneumonia, mediastinitis, pericarditis, sepsis, and status epilepticus.- - - - - - - - - - ranking = 0.68228765419359keywords = retropharyngeal abscess, retropharyngeal (Clic here for more details about this article) |
7/16. Anaerobic mediastinitis.Anaerobic bacteria often are neglected in discussions of the bacteriology of mediastinitis. Two cases of anaerobic mediastinitis are reported and the literature in this field is reviewed. Anaerobes are important pathogens in the etiology of mediastinitis secondary to perforation of the esophagus, extension of a retropharyngeal abscess, or extension of cellulitis or abscess of dental origin from the neck. Although anaerobes indigenous to the oral cavity predominate in these cases, there are also a few cases reported involving bacteroides fragilis. The source of the mediastinitis should be considered when antimicrobial therapy is initiated so that appropriate anaerobic coverage can be included when indicated.- - - - - - - - - - ranking = 0.13645753083872keywords = retropharyngeal abscess, retropharyngeal (Clic here for more details about this article) |
8/16. mediastinitis and bilateral pyopneumothorax complicating a parapharyngeal abscess.A 38-year-old male suffered from mediastinitis, pericarditis, and bilateral sudden pyopneumothorax as a complication of the parapharyngeal abscess that ruptured into the hypopharynx. The full diagnosis remained obscure until the complete clinical picture evolved. Antibiotics and pleural and cervical drainage failed to alleviate the symptoms. Recovery commenced only after tamponade of the retropharyngeal space, which terminated the flow of air and saliva from the neck to the thorax. The anatomic relation of the spaces concerned are discussed, as well as the therapeutic and surgical approaches. the importance of the retropharyngeal space, which may serve as a conduit between the neck and the mediastinum, is pointed out.- - - - - - - - - - ranking = 0.04479728412897keywords = retropharyngeal (Clic here for more details about this article) |
9/16. empyema and mediastinitis complicating retropharyngeal abscess.A 21 year old man with a retropharyngeal abscess complained of right sided chest pain, and chest radiography and thoracocentesis revealed an empyema. A computed tomographic scan of the chest showed a posterior mediastinal abscess communicating with the right pleural cavity. Emergency thoracotomy was performed and the mediastinal abscess and empyema were drained.- - - - - - - - - - ranking = 0.68228765419359keywords = retropharyngeal abscess, retropharyngeal (Clic here for more details about this article) |
10/16. 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 of antibiotics, the mortality of DNM is still around 40%. In spite of drainage of a localized neck abscess, and the administration of systemic antibiotics, the retropharyngeal abscess extended to the pericardial and pleural cavities. Several drainage procedures and thoracotomies were performed to treat the bilateral empyemas and purulent pericarditis. 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 importance of proper mediastinal drainage, as well as the systemic administration of antibiotics, must be emphasized.- - - - - - - - - - ranking = 0.81874518503231keywords = retropharyngeal abscess, retropharyngeal (Clic here for more details about this article) |
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