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Ann Thorac Surg 2000;69:1296
© 2000 The Society of Thoracic Surgeons

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CORRESPONDENCE

Classification of descending necrotizing mediastinitis

^a Department of Thoracic and Cardiovascular Surgery, Jichi Medical School, 3311-1 Yakushiji, Minamikawachi, Kawachi, Tochigi 329-0498, Japan

To the Editor

We read with great interest the recent article by Marty-Ané and associates [1]. Descending necrotizing mediastinitis (DNM) is a rare but fatal disease. We congratulate them on their excellent results.

Recently we proposed the simple classification of the degree of diffusion of DNM based on computed tomography [2]. Type I is localized in the upper mediastinum above the tracheal bifurcation and may not always require aggressive mediastinal drainage. Type IIA extends to the lower anterior mediastinum. Type IIB extends to the anterior and lower posterior mediastinum and demands complete mediastinal drainage with debridement by thoracotomy. We think subxiphoidal mediastinal drainage or thoracoscopic operation without sternotomy may provide adequate drainage in type IIA.

We completely agree with the comment of Marty-Ané and colleagues regarding the causes of the high mortality rate in DNM. Delayed diagnosis and inadequate drainage are fatal. We believe our classification is of use for describing the degree of DNM as well as for determining the treatment.

References

1. Marty-Ané C.H., Merthet J.P., Alric P., Pegis J.D., Rouviere P., Mary H. Management of descending mediastinitis. Ann Thorac Surg 1999;68:212-217.[Abstract/Free Full Text]
2. Endo S., Murayama F., Hasegawa T., et al. Guideline of surgical management based on diffusion of descending necrotizing mediastinitis. Jpn J Thorac Cardiovasc Surg 1999;47:14-19.[Medline]

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hasegawa, T. Articles by Sohara, Y. Search for Related Content PubMed Articles by Hasegawa, T. Articles by Sohara, Y. Related Collections Related Article