A case of necrotizing mediastinitis induced by acute pyoper icardium

Abstract

Deep neck infection is a potentially life-threatening disease, especially complicated with descending necrotizing mediastinitis (DNM). The mean age of DNM is 49–57.8 years old. The commonly seen causes are tonsillar, pharyngeal infection and odontogenic origins. When the deep neck infection extended to the mediastinal spaces, the pleural effusion or pericardial effusion may appear. Here is a rare young lady who had fever and sore throat for 2 weeks, and chest X-ray showed bilateral pleural effusion. After surgical drainage, the Escherichia coli grew over the culture of pericardial effusion. This case is rarely seen in the presence of Escherichia coli pyopericardium originating from DNM in the past. Overall mortality rate of DNM is around 11.2%–17% nowadays. We should keep in mind that for DNM, early diagnosis and aggressively surgical intervention with suitable drainage, and intensive postoperative care should be conducted to lower the morbidity and mortality.

Keywords

• Escherichia coli
• Pyopericardium
• Deep neck infection
• Descending necrotizing mediastinitis
• Septic shock