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Postgraduate Medical Journal Feb 1995Descending necrotising mediastinitis is a rare but serious complication of oropharyngeal infections with high mortality. Diagnosis is frequently delayed, contributing to... (Review)
Review
Descending necrotising mediastinitis is a rare but serious complication of oropharyngeal infections with high mortality. Diagnosis is frequently delayed, contributing to this high mortality, but awareness of such a complication and early diagnosis using computed tomographic scanning leads to prompt surgical drainage, proper antibiotic therapy, and survival.
Topics: Adult; Humans; Male; Mediastinitis; Middle Aged; Necrosis; Peritonsillar Abscess; Tomography, X-Ray Computed
PubMed: 7724444
DOI: 10.1136/pgmj.71.832.98 -
Multimedia Manual of Cardiothoracic... May 2023Paragangliomas are tumours originating from the autonomic nervous system and rarely occur in the chest. They may manifest through symptoms of excess catecholamine...
Paragangliomas are tumours originating from the autonomic nervous system and rarely occur in the chest. They may manifest through symptoms of excess catecholamine release or due to local compression, can be an incidental finding on a computed tomography/magnetic resonance imaging examination or can be found when screening patients with specific gene mutations. Surgical removal is indicated in case of symptoms, (imminent) compression of vital structures or to prevent progression to malignancy. Resection of a paraganglioma in the middle mediastinum can be challenging. The relationship of the tumour to vital structures and its blood supply determine the surgical access route. In this case report, a large paraganglioma situated in the middle mediastinum is resected. Because of the close relationship to vital structures and the presence of feeding arteries from the aortic arch, a transsternal transpericardial approach is chosen. After a median sternotomy, stepwise dissection between the aorta, superior caval vein and right pulmonary artery and the opening of the posterior pericardium gives access to the middle mediastinum and the area between the tracheal bifurcation and the left atrial roof. These steps can be done without cardiopulmonary bypass. After identification and division of the feeding aortic arch arteries, the highly vascularized tumour can be further dissected and removed.
Topics: Humans; Vena Cava, Superior; Mediastinal Neoplasms; Paraganglioma; Mediastinum; Aorta, Thoracic
PubMed: 37212249
DOI: 10.1510/mmcts.2023.010 -
Journal of Cardiothoracic Surgery Jun 2023Treatment of esophageal perforation or rupture is complicated and controversial, especially in advanced cases. In fact, it is generally accepted that this disease must... (Review)
Review
Treatment of esophageal perforation or rupture is complicated and controversial, especially in advanced cases. In fact, it is generally accepted that this disease must be treated individually according to the location, causes and clinical features of rupture or perforation. A very rare case was admitted to our department, who was injured 5 days ago by high-pressure gas of a running air compressor and resulted in a long-term longitudinal rupture of the thoracic esophagus. Although the patient suffered from empyema and mediastinitis at the same time, and his condition was very serious, the debridement and desquamation of empyema were still implemented, followed by left thoracic esophagectomy and left neck approach esophagogastrostomy in the same period successfully. The patient got a good result finally.
Topics: Humans; Mediastinitis; Esophageal Perforation; Empyema; Esophagectomy; Esophagoplasty
PubMed: 37312152
DOI: 10.1186/s13019-023-02208-2 -
European Respiratory Review : An... Dec 2021The diagnosis of a mediastinal mass may be challenging for clinicians, since lesions arising within the mediastinum include a variety of disease entities, frequently... (Review)
Review
The diagnosis of a mediastinal mass may be challenging for clinicians, since lesions arising within the mediastinum include a variety of disease entities, frequently requiring a multidisciplinary approach. Age and sex represent important information, which need to be integrated with imaging and laboratory findings. In addition, the location of the mediastinal lesion is fundamental; indeed, we propose to illustrate mediastinal diseases based on the compartment of origin. We consider that this structured approach may serve as hint to the diagnostic modalities and management of mediastinal diseases. In this review, we present primary mediastinal tumours in the evolving context of new diagnostic and therapeutic tools, with recently described entities, based on our own experience with >900 cases encountered in the past 10 years.
Topics: Diagnostic Imaging; Humans; Mediastinal Neoplasms; Mediastinum
PubMed: 34615701
DOI: 10.1183/16000617.0309-2020 -
Medicine Apr 2023Descending necrotizing mediastinitis (DNM) is a rare but severe mediastinal infection. If not diagnosed and treated promptly, the consequences can be very serious. Here,... (Review)
Review
RATIONALE
Descending necrotizing mediastinitis (DNM) is a rare but severe mediastinal infection. If not diagnosed and treated promptly, the consequences can be very serious. Here, we shared a successful diagnosis and treatment case of DNM that originates from oral to neck and mediastinum caused by Streptococcus constellatus (S constellatus). S constellatus is a clinically uncommon gram-positive coccus and is known for its ability to form abscesses. Timely surgical drainage and the correct use of antibiotics are key to successful treatment.
PATIENT CONCERNS
A 53-year-old male admitted to hospital with painful swelling of the right cheek, persistent oral pus and moderate fever lasting 1 week, followed by rapid development of a mediastinal abscess.
DIAGNOSES
He was diagnosed with DNM caused by S constellatus.
INTERVENTIONS
On the evening of admission, an emergency tracheotomy and thoracoscopic exploration and drainage of the right mediastinum, floor of the mouth, parapharynx and neck abscess were performed. Antibiotics were administered immediately.
OUTCOMES
At 28 days post-operatively, the abscess was absorbed, bilateral lung exudate decreased and the patient temperature, aspartate transaminase, alanine transaminase, bilirubin and platelets returned to normal. The patient was discharged after completing 4 weeks of antibiotic therapy. Follow-up at 3 months after discharge revealed no recurrence of the abscess.
LESSONS
Early surgical drainage and antibiotics treatment are important in mediastinal abscesses and infectious shock due to Streptococcus asteroids.
Topics: Male; Humans; Middle Aged; Mediastinitis; Abscess; Streptococcus constellatus; Mediastinum; Mediastinal Diseases; Drainage; Anti-Bacterial Agents; Necrosis
PubMed: 37026905
DOI: 10.1097/MD.0000000000033458 -
Annals of Surgery May 1960
Topics: Humans; Mediastinitis; Neoplasms
PubMed: 13813970
DOI: 10.1097/00000658-196005000-00019 -
Archives of Pathology & Laboratory... Dec 2005Frozen section of lung tissue is performed to guide the surgeon in subsequent therapy. (Review)
Review
CONTEXT
Frozen section of lung tissue is performed to guide the surgeon in subsequent therapy.
DESIGN
Practical experience in frozen section of the lung was reviewed in the medical literature and from the records of several academic hospitals.
RESULTS
Most frozen sections of the lung are performed for evaluation of a solitary nodule, a mass, or the surgical margins of a resection. Frozen section may also be used to assess the adequacy of a lung wedge biopsy taken for later diagnosis of a condition.
CONCLUSION
The pathologic evaluation of intraoperative pulmonary lesions is indicated for the differential diagnosis of pulmonary nodules and masses, both neoplastic and nonneoplastic, surgical resection margins, and mediastinal lymph nodes. The most worrisome pitfalls involve differentiating benign reactive atypia from malignancy on frozen section.
Topics: Diagnosis, Differential; Frozen Sections; Humans; Intraoperative Period; Lung; Lung Diseases; Lymph Nodes; Mediastinum; Pathology, Surgical
PubMed: 16329732
DOI: 10.5858/2005-129-1602-FSOLS -
Journal of Radiology Case Reports Aug 2023We report a case of descending necrotizing mediastinitis (DNM) in a 68-year-old male who presented in acute respiratory distress accompanied with anterior cervical neck...
We report a case of descending necrotizing mediastinitis (DNM) in a 68-year-old male who presented in acute respiratory distress accompanied with anterior cervical neck swelling and pain with swallowing. Contrast enhanced computed tomography (CECT) of the neck demonstrated a large, peripherally enhancing retropharyngeal fluid and air collection that appeared to communicate with a fluid and air collection within the mediastinum. CECT of the chest demonstrated punctate foci of air and fat stranding along the anterior and superior mediastinum. Radiological evidence and the presence of necrosis on surgical debridement of the retropharyngeal abscess established the diagnosis of DNM. This case emphasizes the role of computed tomography (CT) in the diagnosis of DNM and demonstrates the utility of chest imaging in a high-risk patient who presents with a retropharyngeal abscess.
Topics: Aged; Humans; Male; Drainage; Mediastinitis; Neck; Necrosis; Radiography; Retropharyngeal Abscess; Tomography, X-Ray Computed
PubMed: 38090639
DOI: 10.3941/jrcr.v17i8.5095 -
Thorax Aug 1997Descending necrotising mediastinitis is caused by downward spread of neck infection and has a high fatality rate of 31%. The seriousness of this infection is caused by... (Review)
Review
BACKGROUND
Descending necrotising mediastinitis is caused by downward spread of neck infection and has a high fatality rate of 31%. The seriousness of this infection is caused by the absence of barriers in the contiguous fascial planes of neck and mediastinum.
METHODS
The recent successful treatment of seven adult patients with descending necrotising mediastinitis emphasises the importance of optimal early drainage of both neck and mediastinum and prolonged antibiotic therapy. The case is also presented of a child with descending necrotising mediastinitis, demonstrating the rapidity with which the infection can develop and lead to death. Twenty four case reports and 12 series of adult patients with descending necrotising mediastinitis published since 1970 were reviewed with meta-analysis. In each case of confirmed descending necrotising mediastinitis the method of surgical drainage (cervical, mediastinal, or none) and the survival outcome (discharge home or death) were noted. The chi 2 test of statistical significance was used to detect a difference between cases treated with cervical drainage alone and cases where mediastinal drainage was added.
RESULTS
Cervical drainage alone was often insufficient to control the infection with a fatality rate of 47% compared with 19% when mediastinal drainage was added (p < 0.05).
CONCLUSIONS
Early combined drainage with neck and chest incisions, together with broad spectrum intravenous antibiotics, should be considered standard care for this disease.
Topics: Adult; Aged; Anti-Bacterial Agents; Drainage; Fatal Outcome; Female; Humans; Male; Mediastinitis; Middle Aged; Neck; Necrosis; Thorax; Tomography, X-Ray Computed
PubMed: 9337829
DOI: 10.1136/thx.52.8.702 -
Pulmonary Medicine 2016. Endobronchial ultrasound (EBUS) is a procedure that provides access to the mediastinal staging; however, EBUS cannot be used to stage all of the nodes in the... (Meta-Analysis)
Meta-Analysis Review
. Endobronchial ultrasound (EBUS) is a procedure that provides access to the mediastinal staging; however, EBUS cannot be used to stage all of the nodes in the mediastinum. In these cases, endoscopic ultrasound (EUS) is used for complete staging. . To provide a synthesis of the evidence on the diagnostic performance of EBUS + EUS in patients undergoing mediastinal staging. . Systematic review and meta-analysis to evaluate the diagnostic yield of EBUS + EUS compared with surgical staging. Two researchers performed the literature search, quality assessments, data extractions, and analyses. We produced a meta-analysis including sensitivity, specificity, and likelihood ratio analysis. . Twelve primary studies (1515 patients) were included; two were randomized controlled trials (RCTs) and ten were prospective trials. The pooled sensitivity for combined EBUS + EUS was 87% (CI 84-89%) and the specificity was 99% (CI 98-100%). For EBUS + EUS performed with a single bronchoscope group, the sensitivity improved to 88% (CI 83.1-91.4%) and specificity improved to 100% (CI 99-100%). . EBUS + EUS is a highly accurate and safe procedure. The combined procedure should be considered in selected patients with lymphadenopathy noted at stations that are not traditionally accessible with conventional EBUS.
Topics: Bronchoscopy; Endosonography; Humans; Lung Neoplasms; Lymphatic Metastasis; Mediastinum; Neoplasm Staging; Reproducibility of Results; Sensitivity and Specificity
PubMed: 27818796
DOI: 10.1155/2016/1024709