Cases reported "Mediastinitis"

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1/45. Descending necrotizing mediastinitis: report of a case.

    A 47-year-old man was admitted to our hospital for treatment of an odontogenic infection. He presented with a fever, signs of sepsis, and neck swelling, and was initially diagnosed as having a neck abscess. After cervical drainage, he showed no improvement, and mediastinitis was detected by chest X-ray and computed tomography. A thoracotomy and mediastinal drainage was subsequently performed for descending necrotizing mediastinitis, which resulted in marked improvement. To date, only 83 cases of descending necrotizing mediastinitis have been reported in japan. We present herein an additional case, followed by a review of the Japanese literature.
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keywords = neck
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2/45. Descending necrotizing mediastinitis with sternocostoclavicular osteomyelitis and partial thoracic empyema: report of a case.

    We present herein the case of a 50-year-old woman in whom descending necrotizing mediastinitis originating from an anterior neck abscess spread to the left upper bony thorax, resulting in osteomyelitis of the left sternocostoclavicular articulation and left partial thoracic empyema. Transcervical mediastinal irrigation and drainage was performed with aggressive antibiotic therapy, followed by resection of the left sternocostoclavicular joint and debridement of the anterior mediastinum. The patient had an uneventful postoperative course, and her left arm and shoulder mobility was well preserved.
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keywords = neck
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3/45. Spontaneous candida mediastinitis diagnosed by endoscopic ultrasound-guided, fine-needle aspiration.

    candida mediastinitis is a rare clinical entity associated with high mortality and morbidity. It is emerging as an important clinical entity, probably due to increased recognition of candida as a significant pathogen in mediastinitis. candida mediastinitis is usually associated with cardiothoracic surgery, esophageal perforation, and head and neck infections. Optimal therapy for candida mediastinitis remains undefined. Aggressive, combined surgical debridement and antifungal therapy appears to be the most effective of available therapies. We report a case of spontaneous candida mediastinitis diagnosed by endoscopic ultrasound-guided, fine-needle aspiration and successfully treated with oral antifungal therapy alone.
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keywords = neck
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4/45. Sclerosing cervicitis: homologue of sclerosing retroperitonitis and mediastinitis.

    The first known case of an invasive, sclerosing fibrosis of the deep soft tissue of the neck is presented. The morbidity, clinical course, and, most importantly, pathological identity with sclerosing retroperitonitis and sclerosing mediastinitis led us to consider this lesion as the cervical homologue of these lesions, ie, sclerosing cervicitis.
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5/45. CT findings of descending necrotising mediastinitis via the carotid space ('Lincoln Highway').

    A 3-year-old girl with fever and neck swelling showed widening of the superior mediastinum on chest radiographs. Contrast-enhanced CT of the neck revealed ill-defined low-attenuation areas with a thick, enhanced rim adjacent to the hypertrophied palatine tonsil. The abscess extended inferiorly within the carotid sheath between the carotid artery and the internal jugular vein into the anterior mediastinum. The carotid space is considered an important conduit of descending necrotising mediastinitis and is called the 'Lincoln Highway' as previously suggested.
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keywords = neck
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6/45. A rare complication of tooth abscess--ludwig's angina and mediastinitis.

    Deep neck infections are a rare but potentially fatal complication of pulpal abscess of the teeth. If an infection can progress rapidly from a toothache to a life-threatening infection, then it is critical that dentists be able to recognize the danger signs and identify the patients who are at risk. This article reviews a case of a seemingly innocuous toothache which rapidly progressed to ludwig's angina and mediastinitis, and discusses how to recognize and manage these life-threatening infections.
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keywords = neck
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7/45. mediastinitis after percutaneous dilatational tracheostomy.

    In our experience, PDT after total arch replacement, especially after dissection of neck vessels, should be approached with caution. A long skin incision that allows discharge to drain from the wound and a sufficiently long postoperative tracheostomy period to allow tissue healing in the neck are necessary for prevention of mediastinitis.
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keywords = neck
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8/45. Acute mediastinal widening.

    Mediastinal abscess resulting from descending necrotizing mediastinitis is a rare infectious process. Odontogenic infections are the most commonly implicated underlying process. Descending necrotizing mediastinitis is a rapidly progressive infectious process that spreads through the fascial planes of the neck to gain access to the mediastinum. Early recognition of descending necrotizing mediastinitis is important because the reported mortality rate is 30% to 50% even in the antibiotic era. Clues to the diagnosis of descending necrotizing mediastinitis include evidence of severe oropharyngeal infection, neck swelling and crepitations, and complaints of dysphagia and odynophagia. Lateral radiographs of the neck sometimes show gas pockets, but chest films are often negative early in the disease process. A late chest x-ray finding is widening of the superior mediastinum. Therefore, computed tomography (CT) is the imaging procedure of choice. Optimal treatment includes adequate drainage of the neck and mediastinum and broad spectrum intravenous antibiotics. Commonly implicated organisms are alpha-hemolytic streptococci and bacteroides fragilis.
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ranking = 2
keywords = neck
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9/45. Descending necrotizing mediastinitis: report of a case following steroid neck injection.

    Cervical necrotizing fasciitis is a rare, rapidly progressive, severe bacterial infection of the soft tissues of the neck. Uncommonly, it may descend into the mediastinum. We describe a case of descending necrotizing mediastinitis in a young man, where there was diagnostic confusion and delay, with an eventual fatal outcome. A steroid injection for neck pain is thought to be the source of infection. In this case, the signs of mediastinitis were initially masked, and the diagnosis delayed until cardiopulmonary arrest occurred. Early recognition with a low threshold for computed tomography (CT) scanning is essential. Aggressive multidisciplinary therapy with mediastinal drainage is mandatory.
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ranking = 3
keywords = neck
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10/45. Descending necrotizing mediastinitis following acute epiglottitis: a case report.

    Descending necrotizing mediastinitis occurs secondary to deep neck infection, and the primary focus of infection is mostly located in the tonsil, pharynx and carious tooth. DNM following acute epiglottitis is quite rare, with only one case reported. We treated an 84-year old female with an acute epiglottitis followed by DNM. She was successfully treated by drainages with cervical surgery combined with thoracotomy and cervical surgery.
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