Descending necrotizing mediastinitis: increased mortality due to delayed presentation

Aim: To describe the clinical features of descending necrotizing mediastinitis (DNM) and to outline the diagnostic and therapeutic measures to be taken in its management. Materials and methods: We retrospectively analyzed the data from 13 patients with DNM treated between 2001 and 2012 in 2 tertiary care centers, together with their demographics, diagnostic methods, therapeutic interventions, and clinical outcomes. Results: The patients consisted of 10 males and 3 females, aged from 16 to 72 years (mean age: 44). Odontogenic and tonsillar infections were the probable sources of infection in the majority of cases. Computerized tomography is a crucial imaging modality in the diagnosis and follow-up of patients with DNM. All patients underwent surgical treatment in addition to intravenous broad-spectrum antibiotics. Tube thoracostomy, mediastinal drainage, cervical drainage, and thoracotomy were the therapeutic measures utilized in these patients. Five patients were lost (38%) and 8 survived. Conclusion: DNM is a life-threatening condition that may originate from oropharyngeal infections. Emergency surgical intervention is mandatory in the management of DNM. The 2 most important survival factors are early surgical intervention and adequate drainage.