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Age: 10 months

Sex: Female

Indication: Drooling, fever, lethargy

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Case #2


Findings

  • Extensive multispace infection in the left neck involving the parotid, parapharyngeal, pharyngeal mucosal, and retropharyngeal spaces with extension laterally across midline along and within the thyroid gland and extension inferiorly via the left carotid and retropharyngeal spaces into the upper mediastinum with a complex multiloculated mediastinal collection and extensive surrounding edema
  • Mass effect on the left internal jugular vein with long segment thrombosis
  • Extension of the infectious process into the left pleural space with a small left apical empyema
  • Small layering right apical pleural effusion, sterility indeterminate
  • Biapical airspace disease


Diagnosis

  • Descending necrotizing mediastinitis

Sample Report

Multispace abscess and cellulitis involving the left neck with inferior extension via the carotid and retropharyngeal spaces into the upper mediastinum resulting in necrotizing mediastinitis as well as left and possible right small empyemas. Urgent surgical consultation is recommended.

Mass effect upon and thrombosis of the left internal jugular vein.


Discussion

  • Descending necrotizing mediastinitis is rare but dreaded complication of aggressive neck infections, which can descend into the mediastinum via either the retropharyngeal or carotid spaces
  • There is high associated mortality, so early antibiotics and surgical debridement are key to survival


Images

Red arrows: extension of infection through the retropharyngeal space. Red arrows: extension of infection through the carotid space.



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