Search

Pharyngeal or esophageal perforation with mediastinal abscess is notably dangerous in children and can be very difficult to treat. We aimed to determine the safety and efficacy of the transnasal placement of a mediastinal drainage catheter and a nasojejunal feeding tube, with or without gastric decompression, in the treatment of the above perforations in children. We placed transnasal mediastinal drainage catheters and nasojejunal feeding tubes in 14 pediatric patients. Patients with esophageal perforation also underwent the placement of a gastric decompression tube. Four of these patients additionally received chest drainage tubes. The fistula healed after a median of 66 days (range, 5–404 days). Corrosive esophagitis occurred in two patients with pharyngeal perforations. One of these patients underwent surgical treatment 2 months after fistula healing, and the other underwent repeated balloon dilatation procedures for cicatricial restenosis. Four months after the fistula had healed, the patients with esophageal perforations were all free from recurrence. The use of interventional radiology to place a transnasal mediastinal drainage catheter, a nasojejunal feeding tube, and a gastric decompression tube is a safe, easy, inexpensive, and efficacious way to treat pharyngeal or esophageal perforation complicated by mediastinal abscess in children. Treatment study. Level IV. [ABSTRACT FROM AUTHOR]

Background and objective Mediastinal infection is a serious infection of mediastinal connective tissue, with more complications and higher mortality. Application of broad-spectrum antibiotics and nutritional support, early sufficient drainage is the key to successful treatment. In the mode of drainage, this paper discusses the application of continuous negative pressure drainage technique to treat acute anterior mediastinal infection of severe mouth pharynx source, and the good results are summarized and shared. Methods In January to December in 2017, a total of 17 cases treated acute mediastinal infection is derived from the throat, has formed a mediastinal abscess, surgery adopts retrosternal counterpart negative pressure drainage way, namely the sternum nest and free sternum xiphoid process under the incision on the first mediastinal clearance, make breakthrough and placed drainage device, suture closed wound, continuous negative pressure drainage, negative pressure using 3 cm-5 cm water column. Results Among the 17 patients, 14 patients were relieved by continuous negative pressure drainage, and then the drainage tube was removed. In 2 cases, the infection broke into the right thoracic cavity, and the closed drainage caused the negative pressure to disappear, and the negative pressure drainage was replaced by the conventional drainage, and the drainage tube was removed after the drainage tube was clear. One patient had formed a mediastinal abscess incision drainage time later, complicated with septic shock and sepsis, resulting in the death of multiple organ failure. Conclusion The traditional treatment of severe acute mediastinal infection is sternal incision and drainage. Continuous negative pressure drainage adequate drainage of mediastinal can relieve patients' pain, effusion, and avoid the dressing out repeatedly. It is an effective method. However, there are limitations in this method, which need to be further optimized. [ABSTRACT FROM AUTHOR]

Acute Descending Necrotizing Mediastinitis is a rare but serious illness that carries a high mortality rate. It is not commonly part of the Emergency Physician's differential diagnoses for the chief complaint of chest pain when there has been no recent instrumentation to the area. Because the disease is so uncommon, there is a relative paucity of reports of the illness. We report the case of a 58-year-old male with a past medical history of HIV and history of intravenous drug use (IVDU) who presented to the Emergency Department with anterior chest pain for several days in addition to 3 days of fever and chills. The patient's presentation raised concern for intrathoracic infection and the diagnosis of Descending Necrotizing Mediastinitis complicated by internal jugular thrombosis was confirmed by contrast enhanced computed tomography and sonography. [ABSTRACT FROM AUTHOR]

Mediastinal abscess following retropharyngeal abscess is a rare entity. We report the first neonate presenting with a large mediastinal abscess as a complication of a retropharyngeal abscess. The initial manifestations of this newborn were fever and stridor. The chest sonography revealed a mediastinal mass, and the neck and chest computed tomography showed multiple abscesses in the retropharyngeal space, parapharyngeal space, and superior mediastinum. The mediastinal cystic mass was excised, and antibiotic treatment was completed for 7 weeks. She did well without any sequelae at follow-up clinic. Pediatricians should consider retropharyngeal and mediastinal abscesses among the differential diagnoses when confronting a newborn with fever and stridor. [ABSTRACT FROM AUTHOR]

Most mediastinal abscesses result from infections after thoracotomy, esophageal perforation or pene- trating chest trauma. This disease is rarely caused by closed blunt chest trauma. All previously reported such cases after closed blunt chest trauma presented with hematoma and sternal osteomyelitis resulting from sternal fracture. Here we report a 15-year-old sumo wrestler who presented with an anterior mediastinal abscess without any mediastinal fracture. The mediastinal abscess resulted from the hematogenous spread of Staphylococcus aureus to a hematoma that might have been caused by a closed blunt chest trauma incurred during sumo wrestling exercises. [ABSTRACT FROM AUTHOR]

Abstract: Pulmonary mucormycosis is a rare, yet rapidly progressive infection that carries a devastating prognosis. As with pulmonary aspergillosis, angioinvasiveness is a hallmark of disease and causes infarction and necrosis of host tissue. Compared to other angioinvasive fungi, the pace of mucormycosis is usually very fast and spreading to contiguous structures such as mediastinum and heart seems to occur more frequently. We report the case of a patient with localized angioinvasive pulmonary mucormycosis, which was initially mistaken for invasive pulmonary aspergillosis and, following surgical resection, showed early relapse from radiologically inconspicuous postoperative seroma. [Copyright &y& Elsevier]

Abstract: INTRODUCTION: We report a case of reconstruction of the right atrial wall using a novel bioresorbable patch derived from porcine small intestinal submucosa. PRESENTATION OF CASE: Our patient presented with mediastinal aspergillosis as a result of chronic steroid therapy for an oligodendroglioma. Hemodynamic compromise and syncopal episodes secondary to the mass effect of the aspergilloma prolapsing through tricuspid valve necessitated palliative surgical excision. DISCUSSION: Intraoperatively, it was confirmed that the lesion had eroded into the right atrium and partially occluded right ventricular inflow. In order to achieve appropriate palliation a wide resection of the atrial wall was necessary. The atrial reconstruction was then performed using an extracellular matrix-derived biopatch. This case was further complicated by postoperative bleeding requiring re-operation. CONCLUSION: We describe the methods used for repair using a novel patch in this rare case of invasive aspergillosis extending into the right atrium and resulting in compromise of diastolic right ventricular filling. [Copyright &y& Elsevier]

Foreign body perforations of the esophagus are infrequent events yet have the potential to cause significant morbidity and mortality. The clinical consequences of esophageal perforation by a foreign body are dependent upon the severity of infectious sequelae and damage to surrounding structures by the foreign object itself, as detailed in previous published reports. We describe the thoracoscopic management of a mediastinal abscess caused by a foreign body perforation in a patient with an intact esophagus. [ABSTRACT FROM AUTHOR]