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

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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.

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