descending necrotising mediastinitis

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descending necrotising mediastinitis

Mediastinitis which arises from a severe infection of the oropharynx.

Diagnostic criteria
• Evidence of severe cervical infection;
• Radiographic features of mediastinitis;
• Documentated necrotising mediastinits at operation or at postmortem;
• Confirmed link between mediastinitis and oropharyngeal infection.

Clinical findings
Fever, chills, pleuritic/retrosternal pain, SOB, confusion, sore throat, neck swelling, odynophagia.
 
Demographics
More common in men (6:1) in their 30s.
 
Risks
Other medical complaints including HIV, diabetes, drug abuse and cancer; history of recent iatrogenic procedures, such as endoscopy, bronchoscopy, intubation or surgery.

Microbiology
Mixed infection, with slightly geater abundance of strict anaerobic bacteria, comprised of Bacteroides, the most common strict anaerobes, and streptococci, the most common facultative organisms.

Diagnosis
Blood cultures, white cell count, glucose levels to detect diabetes.
 
Imaging
Widening of precervical and retropharyngeal soft tissues by plain films; gas by CT or MRI.

Treatment
Airway maintenance and management; antibiotics, fluid resuscitation.
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