HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Paul D. Kiernan William D. Byrne Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kiernan, P. D. Articles by Vaughan, B. Search for Related Content PubMed PubMed Citation Articles by Kiernan, P. D. Articles by Vaughan, B.

Ann Thorac Surg 1998;65:1483-1488
© 1998 The Society of Thoracic Surgeons

---

Current Review

Descending Cervical Mediastinitis

^a Section of Thoracic Surgery, INOVA Health Systems, Fairfax, Virginia, USA
^b Section of Pulmonary Medicine, INOVA Health Systems, Annandale, Virginia, USA

Address reprint requests to Dr Kiernan, Cardiovascular & Thoracic Surgery Associates, PC, Suite 301, 3301 Woodburn Rd, Annandale, VA 22003

Descending cervical mediastinitis is an uncommonly reported presentation of infection originating in the head or neck and descending into the mediastinum, which is fraught with impressive morbidity and mortality rates of 30% to 40% or more. We present the INOVA–Fairfax–Alexandria Hospital experience with descending cervical mediastinitis, January 1, 1986, to April 1, 1997; in addition we review the English-language medical and surgical literature with regard to this entity. Computed tomography and magnetic resonance imaging serve to aid both diagnosis and management. The application of broad-spectrum antibiotics should initially be empiric, with an eye to coverage of mixed aerobic and anaerobic infections. Definitive treatment mandates early and aggressive surgical intervention. All affected tissue planes, cervical and mediastinal, must be widely debrided, often leaving them open for frequent packing and irrigation. The treating physician must remain always alert to the further extension of infection, which, if it occurs, must be further debrided and drained. Tracheostomy serves a dual role of further opening cervical fascial planes and securing an often compromised airway.

This article has been cited by other articles:

				C. T. Wright, R. M. S. Stocks, D. L. Armstrong, S. R. Arnold, and H. J. Gould Pediatric Mediastinitis as a Complication of Methicillin-Resistant Staphylococcus aureus Retropharyngeal Abscess Arch Otolaryngol Head Neck Surg, April 1, 2008; 134(4): 408 - 413. [Abstract] [Full Text] [PDF]

				M. Gorlitzer, M. Grabenwoeger, J. Meinhart, H. Swoboda, W. Oczenski, N. Fiegl, and F. Waldenberger Descending Necrotizing Mediastinitis Treated With Rapid Sternotomy Followed by Vacuum-Assisted Therapy Ann. Thorac. Surg., February 1, 2007; 83(2): 393 - 396. [Abstract] [Full Text] [PDF]

				N. Isowa, T. Yamada, T. Kijima, K. Hasegawa, and K. Chihara Successful thoracoscopic debridement of descending necrotizing mediastinitis Ann. Thorac. Surg., May 1, 2004; 77(5): 1834 - 1837. [Abstract] [Full Text] [PDF]

				H.-K. Min, Y. S. Choi, Y. M. Shim, Y. I. Sohn, and J. Kim Descending necrotizing mediastinitis: a minimally invasive approach using video-assisted thoracoscopic surgery Ann. Thorac. Surg., January 1, 2004; 77(1): 306 - 310. [Abstract] [Full Text] [PDF]

				E. Papalia, O. Rena, A. Oliaro, A. Cavallo, R. Giobbe, C. Casadio, G. Maggi, and M. Mancuso Descending necrotizing mediastinitis: surgical management Eur. J. Cardiothorac. Surg., October 1, 2001; 20(4): 739 - 742. [Abstract] [Full Text] [PDF]

				D. A. Chung and A. J. Ritchie Videothoracoscopic drainage of mediastinal abscess: an alternative to thoracotomy Ann. Thorac. Surg., May 1, 2000; 69(5): 1573 - 1574. [Abstract] [Full Text] [PDF]

				P. Vaideeswar and S. P. Tandon Further descent of descending necrotizing mediastinitis Ann. Thorac. Surg., October 1, 1999; 68(4): 1443 - 1443. [Full Text] [PDF]

				C.-H. Marty-Ane, J.-P. Berthet, P. Alric, J.-D. Pegis, P. Rouviere, and H. Mary Management of descending necrotizing mediastinitis: an aggressive treatment for an aggressive disease Ann. Thorac. Surg., July 1, 1999; 68(1): 212 - 217. [Abstract] [Full Text] [PDF]