Descending Necrotizing Mediastinitis: A Life-Threatening Infection

Descending necrotizing mediastinitis (DNM) is a severe, life-threatening necrotizing infection of the fascial covering of the mediastinum. An oropharyngeal cavity is connected to the mediastinum through the retropharyngeal space. It is also called the “dangerous space” as along this fascial connection infection from the mouth and neck rapidly spreads to the mediastinum. The negative intrathoracic pressure and gravity facilitate the spread of infection into the thoracic cavity. Common clinical presentations are dysphonia, dry cough, fever, odynophagia, neck swelling, and pain. The imaging studies mainly computerized tomography (CT) of the neck and chest will be diagnostic of DNM. A crucial treatment component is the use of early broad-spectrum antibiotic medication in conjunction with surgical drainage. A combination of trans-cervical and transthoracic drainage has a survival benefit than the trans-cervical drainage alone.