• Deep neck abscess
• Descending necrotizing mediastinitis
• Intensive care
• Mortality
• Prognosis

• Humans
• Male
• Mediastinitis/mortality
• Mediastinitis/etiology
• Mediastinitis/diagnosis
• Mediastinitis/surgery
• Mediastinitis/therapy
• Female
• Middle Aged
• Retrospective Studies
• Neck
• Hospital Mortality
• Abscess/complications
• Abscess/mortality
• Intensive Care Units
• Prognosis
• Adult
• Risk Factors
• Necrosis
• Debridement
• Aged

• CT
• Ludwig’s angina
• computed tomography
• necrotizing mediastinitis
• odontogenic infection

• nomogram
• oral and maxillofacial space infection
• progonosis

• Biological Sample Bank Project of the Ninth People's Hospital affiliated with Shanghai Jiao Tong University School of Medicine
• National Natural Science Foundation of China

• descending mediastinitis
• descending necrotizing mediastinitis
• ent pathology
• mediastinitis management
• multidisciplinary management

• descending necrotizing mediastinitis
• empyema
• mediastinal infection
• omental flap
• perivascular involvement
• staged surgery

• descending necrotizing mediastinitis
• mortality
• pathogenesis
• surgery

• Cervical trauma
• Descending necrotizing mediastinitis
• Whiplash

• Fondation des Hopitaux Robert Schuman

• Child
• Humans
• Oropharynx

• None

• Descending necrotizing mediastinitis
• Esophageal perforation
• Esophagectomy

• descending necrotizing mediastinitis
• surgical treatment
• transcervical drainage
• transthoracic drainage
• video-assisted thoracic surgery

• Acute necrotizing mediastinitis (ANM)
• outcomes
• thoracotomy
• video-assisted thoracic surgery (VATS)

• C-reactive protein
• deep neck infection
• diabetes mellitus
• elderly
• immunocompromised

• anaerobes
• anaerobes of clinical importance
• deep neck space infection
• descending necrotizing mediastinitis
• mediastinitis management
• odontogenic infections
• thoracic empyema
• video-assisted thoracoscopic surgery (vats)

• deep neck infection
• diabetes mellitus
• hospitalization
• long-term
• mediastinitis
• multiple space involvement

• Collar mediastinotomy
• Deep neck infection
• Endo classification
• Mediastinitis
• Quality of life
• Transcervical drainage

• abscess
• deep neck space infection
• dni
• head and neck
• infection

• Descending necrotizing mediastinitis
• Infections
• Surgery
• Video-assisted thoracic surgery

• bronchoesophageal fistula
• esophageal cancer
• esophagectomy
• gastric conduit
• minimally invasive management

• abscess
• odontogenic infection
• surgical drain
• tracheostomy

• Deep neck infections
• Descending necrotizing mediastinitis
• Mortality
• Prognostic factors

• deep neck infection
• malnutrition
• mediastinitis
• mortality
• predictive model
• renal insufficiency

• Cervicofacial
• Computed tomography
• Infection
• Odontogenic
• Reoperation

• Abscess/drug therapy
• Drainage/methods
• Humans
• Reoperation
• Retrospective Studies
• Tomography, X-Ray Computed

• 82100961 National Natural Science Foundation of China

Deep neck infection (DNI) is a serious disease that can lead to severe morbidity, including esophageal perforation, and mortality. However, no previous study has explored the risk factors associated with esophageal perforation in patients with DNI. This study investigated these factors.

Between September 2015 and September 2021, 521 patients with DNI were studied. Relevant clinical variables and deep neck spaces were assessed.

In a multivariate analysis, involvement of the retropharyngeal space (OR 5.449, 95% CI 1.603–18.51, p = 0.006) and the presence of mediastinitis (OR 218.8, 95% CI 55.98–855.3, p < 0.001) were independent risk factors associated with esophageal perforation in patients with DNI.

There were no differences in pathogens between 32 patients with and 489 patients without esophageal perforation (all p > 0.05).

Involvement of the retropharyngeal space and the presence of mediastinitis were independent risk factors associated with esophageal perforation in patients with DNI. There were no differences in pathogens between the groups with and without esophageal perforation in DNI.

• Deep neck infection
• Esophageal perforation
• Mediastinitis
• Retropharyngeal space

Descending necrotizing mediastinitis (DNM) is an acute, rare, severe condition with high mortality, but the optimal management protocol is still controversial. We retrospectively analyzed the results of multidisciplinary management in patients treated for DNM at our center over the last twenty years. Fifteen male patients, mean age 49.07 ± 14.92 years, were treated: 9 with cervico-pharyngeal etiopathogenesis, 3 peri-tonsillar/tonsillar, 2 odontogenic, 1 post-surgical; 6 with DNM type I, 6 with type IIA, and 3 with type IIB (Endo’s classification). Mean time between diagnosis and treatment was 2.24 ± 1.61 days. In all cases, mediastinum drainage via thoracotomy was performed after neck drainage via cervicotomy, associated with tooth treatment in two; one required re-operation; tracheostomy was necessary in 9, temporary intensive care unit stay in 4; 6 developed complications, without post-operative mortality. Main isolated germs were Staphylococci and Candida; 7 had polymicrobial infection. The most used antibiotics were meropenem, metronidazole, teicoplanin, third-generation cephalosporins and clyndamicin; anti-fungal drugs were fluconazole, caspofungin and anidulafungin. On multivariate analysis, presence of cardiovascular disease was statistically significantly associated with longer chest tube duration and hospital stay. DNM requires early diagnosis and treatment to reduce mortality and morbidity. The most effective treatment should provide a multidisciplinary approach, combining cervicotomy and thoracotomy to drain all infectious collections with administration and monitoring of the proper antimicrobial therapy.

• Aspiration
• C-reactive protein
• Concurrent
• Deep neck infection
• Old age
• Pneumonia
• Retropharyngeal space

• blood sugar
• deep neck infection
• incision and drainage
• multiple space involvement
• re-operation

• Lemierre’s syndrome
• carotid space
• concurrent
• deep neck infection
• posterior cervical space

Deep neck infection (DNI) is a serious disease of deep neck spaces that can lead to morbidities and mortality. Acute epiglottitis (AE) is a severe infection of the epiglottis, which can lead to airway obstruction. However, there have been no studies of risk factors in patients with concurrent DNI and AE. This study was performed to investigate this issue. A total of 502 subjects with DNI were enrolled in the study between June 2016 and August 2021. Among these patients, 30 had concurrent DNI and AE. The relevant clinical variables were assessed. In a univariate analysis, involvement of the parapharyngeal space (OR = 21.50, 95% CI: 2.905–158.7, p < 0.001) and involvement of the submandibular space (OR = 2.064, 95% CI: 0.961–4.434, p < 0.001) were significant risk factors for concurrent DNI and AE. In a multivariate analysis, involvement of the parapharyngeal space (OR = 23.69, 95% CI: 3.187–175.4, p = 0.002) and involvement of the submandibular space (OR = 2.465, 95% CI: 1.131–5.375, p < 0.023) were independent risk factors for patients with concurrent DNI and AE. There were no differences in pathogens, therapeutic managements (tracheostomy, intubation, surgical drainage), or hospital staying period between the 30 patients with concurrent DNI and AE and the 472 patients with DNI alone (all p > 0.05). However, we believe it is significant that DNI and AE are concurrent because both DNI and AE potentially cause airway obstruction, and concurrence of these two diseases make airway protection more difficult. The infections in critical spaces may cause the coincidence of these two diseases. Involvement of the parapharyngeal space and involvement of the submandibular space were independent risk factors associated with concurrent DNI and AE. There were no differences in pathogens between the concurrent DNI and AE group and the DNI alone group.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a safe and minimally invasive diagnostic tool for mediastinal and hilum evaluation. However, infectious complications may occur after EBUS-TBNA. Among these, mediastinitis and pericarditis are rare.

A 67-year-old woman was referred to our hospital due to paratracheal lymph node enlargement on chest computed tomography (CT). EBUS-TBNA was performed on the lymph node lesions, and prophylactic oral antibiotics were administered. Seven days after EBUS-TBNA, the patient visited the emergency room with a high fever and chest pain. Laboratory test results revealed leukocytosis with a left shift and elevated C-reactive protein level (25.7 mg/dL). Chest CT revealed the formation of a mediastinal abscess in the right paratracheal lymph node and pericardial and bilateral pleural effusions. The patient received intravenous antibiotic treatment, cardiac drainage through pericardiocentesis, and surgical management. The patient recovered favorably and was discharged 31 d after the operation.

Mediastinitis and pericarditis after EBUS-TBNA are rare but should be considered even after the use of prophylactic antibiotics.

• Endoscopic ultrasound-guided fine needle aspiration
• Complication
• Mediastinitis
• Pericarditis
• Antibiotics
• Case report

• Debridement
• Drainage
• Humans
• Mediastinitis/complications
• Mediastinitis/diagnostic imaging
• Necrosis

Mediastinitis is a severe inflammation of the structures located in the mid-chest cavity. Three main causes of infective mediastinitis are traditionally recognized: Deep infection of a sternal wound following cardiothoracic surgery, perforation of the esophagus, and the descending necrotizing mediastinitis as a result of odontogenic, pharyngeal or cervical infections. Mediastinitis, as a complication of skin infection with hematogenous spread is infrequent. Methicillin-resistant Staphylococcus aureus (MRSA) is a gram-positive bacteria, and is responsible for numerous severe infections. MRSA mediastinitis is a rare infection and is typically associated with complications of sternotomy and retropharyngeal abscesses. Here, the second known case of mediastinitis of a hematogenous origin in a non-immunocompromised 41-year-old patient following primary skin infection, accompanied by sternal osteomyelitis, lung consolidation and pleural effusion is described; MRSA was the responsible pathogen. The clinical course was favorable after 6 weeks of antibiotics administration without drainage or surgical intervention.

• mediastinitis
• methicillin-resistant Staphylococcus aureus
• osteomyelitis
• staphylococcal skin infection

• Deep space neck infection
• Descending necrotozing mediastinitis
• Odontogenic infection
• Pharyngeal infection
• Risk factors

• Drainage/adverse effects
• Humans
• Mediastinitis/diagnosis
• Mediastinitis/etiology
• Mediastinitis/surgery
• Neck/surgery
• Necrosis
• Prognosis
• Retrospective Studies

In children, spontaneous mediastinitis is a rare, severe and commonly misdiagnosed disease. Although standard of care treatment frequently involves surgery, we report a case of mediastinitis in a five-year-old child, successfully treated with 4 weeks of intravenous antibiotics. Ultrasound imaging was used to monitor patient response to conservative treatment while reducing radiation exposure.

• deep cervical infection
• group a streptococcus
• ultrasound monitoring

• Pancreatic enzymatic mediastinitis
• Pancreatic fistula
• Pancreatic necrosis
• Splenectomy
• Total gastrectomy

Infections of the deep neck, although becoming scarcer due to the widespread use of antibiotics, still represent a dangerous and possibly deadly disease, especially when descending into the mediastinum. Due to the different specialities involved in the treatment and the heterogenous presentation of the disease, therapeutic standard is still controversial. This study analyzes treatment and outcome in these patients based on a large retrospective review and proposes a therapeutic algorithm.

The cases of 218 adult patients treated with deep neck abscesses over a 10-year period at a tertiary university hospital were analyzed retrospectively. Clinical, radiological, microbiological and laboratory findings were compared between patients with and without mediastinal involvement.

Forty-five patients (20.64%) presented with abscess formation descending into the mediastinum. Those patients had significantly (all items p < 0.0001) higher rates of surgical interventions (4.27 vs. 1.11) and tracheotomies (82% vs. 3.4%), higher markers of inflammation (CRP 26.09 vs. 10.41 mg/dl), required more CT-scans (3.58 vs. 0.85), longer hospitalization (39.78 vs 9.79 days) and more frequently needed a change in antibiotic therapy (44.44% vs. 6.40%). Multi-resistant pathogens were found in 6.67% vs. 1.16%. Overall mortality rate was low with 1.83%.

Despite of the high percentage of mediastinal involvement in the present patient collective, the proposed therapeutic algorithm resulted in a low mortality rate. Frequent CT-scans, regular planned surgical revisions with local drainage and lavage, as well as an early tracheotomy seem to be most beneficial regarding the outcome.

• Deep neck infection
• Mediastinitis
• Microbiology
• Surgical drainage
• Tracheotomy

• Acute mediastinitis
• Chronic fibrosing mediastinitis
• Deep sternal wound infection
• Descending necrotizing mediastinitis
• Esophageal perforation
• Mediastinal granuloma
• Mediastinitis

• Mediastinitis
• Postoperative complication
• Thyroidectomy

• gastrointestinal surgery
• general surgery

• DPC database
• abscess
• deep neck infection
• descending necrotizing mediastinitis
• logistic regression analysis
• mortality
• odds ratio
• oral intake

• Cervical esophageal perforation
• Deep neck infections
• Foreign body
• Rigid esophagoscopy
• Surgical dissection and drainage

• Adult
• Anti-Bacterial Agents/therapeutic use
• Drainage/methods
• Esophageal Perforation/etiology
• Esophageal Perforation/surgery
• Female
• Foreign Bodies/complications
• Foreign Bodies/surgery
• Humans
• Infections/diagnostic imaging
• Infections/etiology
• Infections/therapy
• Male
• Neck/diagnostic imaging
• Neck/surgery
• Retrospective Studies
• Tomography, X-Ray Computed

Mediastinal teratomas occasionally rupture into the thoracic cavity, which induces mediastinitis or various other severe complications. Surgical treatment is crucial for ruptured teratomas; however, few literature reviews to date have addressed the characteristics of ruptured mediastinal teratomas.

We report a 29-year-old woman with severe mediastinitis owing to a mediastinal mature teratoma that ruptured into the mediastinum and right pleural cavity. Surgical resection by median sternotomy was performed within 24 hours after emergency admission. Intraoperative findings demonstrated the ruptured wall of the tumor with exposure of its white contents, which appeared similar to skin and fat, and necrotic tissue in the anterior mediastinum. The tumor was adhered to the right upper lobe, the ascending aorta, and pericardium. Owing to the severe adhesion of the tumor caused by inflammation in the surrounding tissues, a small portion of the tumor could not be removed, and hence complete resection with a sufficient surgical margin was not achieved. Pathologically, the tumor consisted of a solid mass and a cystic mass with severe adhesion to the resected portion of the lung, which included skin and lipid tissue. The tumor was concluded to be a mature teratoma as neither an immature component nor malignant transformation was observed. The patient had an uneventful postoperative course.

To our knowledge, this is the report of successful surgical resection of a ruptured mediastinal teratoma causing severe mediastinitis, with the first literature review of ruptured mediastinal teratomas. We also discuss relevant findings from reports in the literature.

• Mediastinal mature teratoma
• Mediastinitis
• Rupture
• Surgical resection