Diagnosis And Therapy Experience Of Descending Necrotizing Mediastinitis

Objective:To investigate the diagnosis and treatment of descending necrotizing mediastinitis(DNM), and to improve the early diagnostic and curative ratio of DNM.Methods:Clinical data of 8 DNM cases in our hospital, from 2006 to 2009, were reviewed and analyzed in this study.Results:In this group, patients were all made definite diagnosis by clinical situation, neck and chest CT, and germiculture. Six cases were related to odontogenic infection, 6 cases were complicated with diabetes, and 6 cases were mixed with infection. Among the patients with infection, 4 cases were positive in anaerobic culture. One patient only received incision drainage of cervical. Six patients were performed thoratomy. And one patient were performed debridement and drainage through video-assisted thoracoscopic surgery(VATS). Six patients in this group were cured, and the other 2 patients died.Conclusion:Descending necrotizing mediastinitis (DNM) is spreading mostly from the odontoiatric infection in this group. DNM is presenting clinical features of rapid progress and of high mortality when complicated with diabetes. The diagnosis of DNM is based on case history, signs and symptoms, neck and chest CT scanning, and germiculture. Effective treatment includes the early and sufficiently use of broad spectrum antibiotics, and individual surgical managements based on neck and chest CT, such as clearing necrotic tissues, drainage and flushing. Furthermore, more attention should be paid to the treatment of diabetes and nutritional support.