Descending cervical mediastinitis (DCM) is an under-reported and virulent presentation of infection that may arise from odontogenic or cervicofacial infection, esophageal perforation, or trauma.

 

As infection spreads along deep cervical planes into the mediastinum, widespread cellulitis, necrosis, abscess formation, and sepsis may occur.

 

Computed tomography provides complementary information to other studies, as noted in Figure 2 of the appended article. In addition, it may be used to dynamically track craniocaudal extent of the inflammatory or infectious process. In Figure 2 is well illustrated the extent of infection in one of our patients with subcutaneous emphysema (air in the mediastinum), mediastinal engorgement (particularly along the superior mediastinum), and bilateral pleural effusions.

 

Our own recommendations are based on our small but uniformly successful experience (no mortality in the last decade), as well as that published in the literature (where the mortality averages 30%). We advocate broad-spectrum antibiotics in combination with early and aggressive cervical and superior mediastinal drainage, supplemented when mediastinitis persists or whether by lack of clinical improvement of persistent collections by CT scan with other "open" procedures that may be considered for thorough evaluation, evacuation, and debridement of any existing areas of infection. Such reasonable and aggressive definitive surgical exposure and drainage must be effected, similar to treatment of abscesses, which may occur anywhere else.

 

Descending Cervical Mediastinitis

Article Overview

Descending cervical mediastinitis (DCM) is an under-reported and virulent presentation of infection that may arise from odontogenic or cervicofacial infection, esophageal perforation, or trauma. As infection spreads along deep cervical planes into the mediastinum, widespread cellulitis, necrosis, abscess formation, and sepsis may occur.

 

Computed tomography provides complementary information to other studies, as noted in Figure 2 of the appended article. In addition, it may be used to dynamically track craniocaudal extent of the inflammatory or infectious process. In Figure 2 illustrates the extent of infection in one of our patients with subcutaneous emphysema (air in the mediastinum), mediastinal engorgement (particularly along the superior mediastinum), and bilateral pleural effusions.

 

Our own recommendations are based on our small but uniformly successful experience (no mortality in the last decade), as well as that published in the literature (where the mortality averages 30%). We advocate broad-spectrum antibiotics in combination with early and aggressive cervical and superior mediastinal drainage, supplemented when mediastinitis persists or whether by lack of clinical improvement of persistent collections by CT scan with other "open" procedures that may be considered for thorough evaluation, evacuation, and debridement of any existing areas of infection. Such reasonable and aggressive definitive surgical exposure and drainage must be affected similar to treatment of abscesses, which may occur anywhere else.

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