1/3. 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 = physician (Clic here for more details about this article) |
2/3. retropharyngeal abscess presenting as benign neck pain.OBJECTIVE: To present a case of an uncommon presentation of cellulitis of the neck as benign neck pain. CLINICAL FEATURES: A 44-year-old man had severe neck pain and headaches for 2 weeks with an unknown cause. Minimal response to chiropractic treatment leads to coordination of treatment with the patient's primary care physician. Laboratory assessment and magnetic resonance imaging initially were viewed as insignificant but were repeated and showed a retropharyngeal abscess. INTERVENTION AND OUTCOME: chiropractic treatment did not reduce the patient's neck pain as expected. Fusion of C1 to C2 was eventually performed. CONCLUSION: neck pain is a common reason for patients to seek chiropractic care. This case shows an uncommon differential diagnosis for a patient who does not respond quickly to chiropractic treatment for neck pain.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
3/3. Descending cervical mediastinitis.Descending cervical mediastinitis is an uncommonly reported presentation of infection originating in the head or neck and descending into the mediastinum, which is fraught with impressive morbidity and mortality rates of 30% to 40% or more. We present the INOVA-Fairfax-Alexandria Hospital experience with descending cervical mediastinitis, January 1, 1986, to April 1, 1997; in addition we review the English-language medical and surgical literature with regard to this entity. Computed tomography and magnetic resonance imaging serve to aid both diagnosis and management. The application of broad-spectrum antibiotics should initially be empiric, with an eye to coverage of mixed aerobic and anaerobic infections. Definitive treatment mandates early and aggressive surgical intervention. All affected tissue planes, cervical and mediastinal, must be widely debrided, often leaving them open for frequent packing and irrigation. The treating physician must remain always alert to the further extension of infection, which, if it occurs, must be further debrided and drained. tracheostomy serves a dual role of further opening cervical fascial planes and securing an often compromised airway.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |