1/77. Descending suppurative mediastinitis: nonsurgical approach to this unusual complication of retropharyngeal abscesses in childhood.OBJECTIVE: To alert the pediatric emergency physician about suppurative mediastinitis as an unusual, life-threatening complication of retropharyngeal abscesses in children and to report an alternative therapeutic option for these cases. methods: We describe a case of suppurative mediastinitis secondary to a retropharyngeal abscess in a 19-month-old girl and discuss the pathophysiology, diagnosis, and treatment of this disease. RESULTS: Prompt diagnosis, based on clinical, radiographic, and CT findings, followed by immediate retropharyngeal drainage and appropriate antibiotic therapy, allowed conservative management of the mediastinal abscess, without the need for surgery. The child presented a good outcome and was discharged on hospital day 14. CONCLUSIONS: When evaluating a retropharyngeal abscess, the pediatric emergency physician should be aware of its complications. A chest radiograph should be prescribed for each patient presenting with an indolent course. Widening of the mediastinum should be considered as strong evidence of a mediastinal abscess for which the best therapeutic option is aggressive surgical drainage. In the rare cases in which marked improvement is achieved after retropharyngeal drainage, a nonsurgical approach to the mediastinal abscess could be attempted. CT scan and a simple chest radiograph have proved to be useful for diagnosis and follow-up.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
2/77. Descending necrotizing mediastinitis: report of a case.A 47-year-old man was admitted to our hospital for treatment of an odontogenic infection. He presented with a fever, signs of sepsis, and neck swelling, and was initially diagnosed as having a neck abscess. After cervical drainage, he showed no improvement, and mediastinitis was detected by chest X-ray and computed tomography. A thoracotomy and mediastinal drainage was subsequently performed for descending necrotizing mediastinitis, which resulted in marked improvement. To date, only 83 cases of descending necrotizing mediastinitis have been reported in japan. We present herein an additional case, followed by a review of the Japanese literature.- - - - - - - - - - ranking = 0.5keywords = chest (Clic here for more details about this article) |
3/77. aorta-cutaneous fistula as a rare complication of localized chronic mediastinitis.A 35-year-old man was admitted 5 years after congenital heart surgery complicated by staphylococcus aureus and a cutaneous fistula located at the left fourth intercostal space. He was febrile (40 degrees C), suffering from sternal pain and suppuration from the old fistula. During examination arterial blood suddenly discharged from the fistula, so that surgery was immediately instituted. An infected Dacron tube implanting on the ascending aorta for a central aorto-pulmonary shunt was at the origin of a false aneurysm: this had led to the repeat formation of an aorta-cutaneous fistula and outbreak of external bleeding.- - - - - - - - - - ranking = 0.0059752504547388keywords = pain (Clic here for more details about this article) |
4/77. Sternal osteomyelitis and mediastinitis after open-heart operation: pathogenesis and prevention.Sternal osteomyelitis and mediastinitis caused by pseudomonas cepacia developed in a patient undergoing coronary artery bypass two weeks after the operation. P. cepacia bacteremia from a contaminated pressure transducer had preceded and probably caused the chest infection. While other authors have suggested that postoperative sternal osteomyelitis and mediastinitis result from local wound contamination, this case suggests the importance of bacteremia as a cause of such gram-negative infections. Since patients undergoing open-heart operation are exposed to many sources of bacteremia, prevention of severe postoperative chest infections may depend in large part on careful preoperative evaluation of each patienc antibiotic regimens, and, as shown in this patient, on very thorough periodic review of equipment sterilization and intravascular monitoring practices.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
5/77. Successfully treated descending necrotizing mediastinitis through mediansternotomy using a pedicled omental flap.A 21-year-old man with an oropharyngeal abscess admitted to our institution was initially treated with systemic antibiotics but was referred to our department when his condition rapidly deteriorated. His respiratory insufficiency required circulatory support. A computed tomographic scan showed a parapharyngeal abscess descending into the mediastinum with multiple right-side capsulized empyema and pericardial effusion. We conducted emergency surgery through a mediansternotomy using a pedicled omental flap. Postoperative clinical and radiologic assessment showed a normal chest X-ray and primary wound healing without sternal dehiscence. Mediansternotomy using a pedicled omental flap offers excellent exposure for a complete one-stage operation with debridement of all affected tissues of the subauricular region, the mediastinum, and both pleural cavities. We conclude that this method yields good results for patients with acute widespread descending necrotizing mediastinitis.- - - - - - - - - - ranking = 0.5keywords = chest (Clic here for more details about this article) |
6/77. CT findings of descending necrotising mediastinitis via the carotid space ('Lincoln Highway').A 3-year-old girl with fever and neck swelling showed widening of the superior mediastinum on chest radiographs. Contrast-enhanced CT of the neck revealed ill-defined low-attenuation areas with a thick, enhanced rim adjacent to the hypertrophied palatine tonsil. The abscess extended inferiorly within the carotid sheath between the carotid artery and the internal jugular vein into the anterior mediastinum. The carotid space is considered an important conduit of descending necrotising mediastinitis and is called the 'Lincoln Highway' as previously suggested.- - - - - - - - - - ranking = 0.50176794673653keywords = chest, area (Clic here for more details about this article) |
7/77. mediastinitis following graft replacement of the ascending aorta: conservative approach by omental transposition.A 57-year-old patient underwent prosthetic replacement of a previously implanted ascending aorta graft and developed a periprosthetic purulent collection 1 month later. He was successfully treated by debridement of infected tissues, antiseptic irrigation and transposition of an omental flap. The postoperative course was uneventful. A chest computed tomography scan performed 15 months later showed no signs of perigraft infection. Prompt conservative surgical treatment including omental transposition can be effective in the treatment of mediastinitis following graft replacement of the ascending aorta.- - - - - - - - - - ranking = 0.5keywords = chest (Clic here for more details about this article) |
8/77. Death due to bioterrorism-related inhalational anthrax: report of 2 patients.On October 9, 2001, a letter containing anthrax spores was mailed from new jersey to washington, DC. The letter was processed at a major postal facility in washington, DC, and opened in the Senate's Hart Office Building on October 15. Between October 19 and October 26, there were 5 cases of inhalational anthrax among postal workers who were employed at that major facility or who handled bulk mail originating from that facility. The cases of 2 postal workers who died of inhalational anthrax are reported here. Both patients had nonspecific prodromal illnesses. One patient developed predominantly gastrointestinal symptoms, including nausea, vomiting, and abdominal pain. The other patient had a "flulike" illness associated with myalgias and malaise. Both patients ultimately developed dyspnea, retrosternal chest pressure, and respiratory failure requiring mechanical ventilation. leukocytosis and hemoconcentration were noted in both cases prior to death. Both patients had evidence of mediastinitis and extensive pulmonary infiltrates late in their course of illness. The durations of illness were 7 days and 5 days from onset of symptoms to death; both patients died within 24 hours of hospitalization. Without a clinician's high index of suspicion, the diagnosis of inhalational anthrax is difficult during nonspecific prodromal illness. Clinicians have an urgent need for prompt communication of vital epidemiologic information that could focus their diagnostic evaluation. Rapid diagnostic assays to distinguish more common infectious processes from agents of bioterrorism also could improve management strategies.- - - - - - - - - - ranking = 0.50597525045474keywords = chest, pain (Clic here for more details about this article) |
9/77. Mediastinal abscess due to passage of a broncholith.We report a case of a 32-year-old woman who, after passage of broncholiths, developed a mediastinal abscess that required surgical drainage for treatment. Previously reported infectious complications resulting from broncholiths include obstructive pneumonitis and recurrent aspiration pneumonitis secondary to bronchoesophageal fistulas. Because radiographic evidence of abnormal calcification in the chest is common, but rarely is associated with broncholithiasis, the patient's history of lithoptysis was crucial to determining the underlying etiology of her abscess.- - - - - - - - - - ranking = 0.5keywords = chest (Clic here for more details about this article) |
10/77. Fatal inhalational anthrax with unknown source of exposure in a 61-year-old woman in new york city.A 61-year-old woman who was a new york city hospital employee developed fatal inhalational anthrax, but with an unknown source of anthrax exposure. The patient presented with shortness of breath, malaise, and cough that had developed 3 days prior to admission. Within hours of presentation, she developed respiratory failure and septic shock and required mechanical ventilation and vasopressor therapy. Spiral contrast-enhanced computed tomography of the chest demonstrated large bilateral pleural effusions and hemorrhagic mediastinitis. blood cultures, as well as dna amplification by polymerase chain reaction of the blood, bronchial washings, and pleural fluid specimens, were positive for bacillus anthracis. The clinical course was complicated by liver failure, renal failure, severe metabolic acidosis, disseminated intravascular coagulopathy, and cardiac tamponade, and the patient died on the fourth hospital day. The cause of death was inhalational anthrax. Despite epidemiologic investigation, including environmental samples from the patient's residence and workplace, no mechanism for anthrax exposure has been identified.- - - - - - - - - - ranking = 0.5keywords = chest (Clic here for more details about this article) |
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