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Mediastinal masses present a diagnostic challenge due to their similar imaging characteristics, making distinguishing between noninfectious and infectious processes or malignancies difficult. A mediastinal abscess can result in severe life-threatening infections if left untreated. Traditional treatment approaches involve surgical debridement and drainage; however, emerging endobronchial techniques, such as endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), offer a less-invasive means of diagnosing and managing abscesses. Herein, we describe a case of a young male patient who exhibited nonspecific symptoms, including pleuritic chest pain, shortness of breath, and fever. Imaging revealed a mediastinal mass with granuloma formation. EBUS-TBNA successfully drained the abscess, and microbiology analysis confirmed the growth of Streptococcus intermedius. Subsequently, his symptoms resolved, and follow-up imaging demonstrated the resolution of the mass and associated calcifications. Further research is warranted to assess the role of EBUS-TBNA in benign mediastinal masses with granuloma formation. [ABSTRACT FROM AUTHOR]

Wusheng Deng,1,* Yun Jiang,2,* Jiaoxia Qin,1,* Gang Chen,3,* Yongjie Lv,1 Yanmei Lei,1 Jing Luo,1 Kangkang Hong,1 Bing Huang,1 Luhai Qin,4 Xiujia Tang,1 Liumei Ye,1 Yuhai Dang,1 Chao Wang,1 Feiyang Long,1 Ke Wang,1 Jinliang Kong1 1Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China; 2Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Shaoyang University, Shaoyang, Hunan, People’s Republic of China; 3Department of Pathology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China; 4Department of Pulmonology, Hechi Traditional Chinese Medicine Hospital, Hechi, Guangxi, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jinliang Kong; Ke Wang, Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, People’s Republic of China, Email kjl071@163.com; keewang@hotmail.comBackground: Aspergillus fumigatus is an opportunistic fungal pathogen, which is commonly found in lungs and rarely causes infections in mediastinum. Mediastinal Aspergillus abscess is a serious infectious condition, and is characterized by difficult diagnosis due to its clinical manifestations being nonspecific.Case Presentation: Here, we report a case of a mediastinal Aspergillus fumigatus abscess in an immunocompetent patient. The patient was a 45-year-old woman who presented with a 20-day history of sore throat without any underlying diseases. Chest computed tomography (CT) showed a mass in the anterior superior mediastinum. Metagenomic next-generation sequencing (mNGS) identified Aspergillus fumigatus sequences in endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) tissue, indicating the mediastinal Aspergillus fumigatus infection of this patient. The following mediastinal biopsy histological analysis and tissue fungi culture also suggested Aspergillus fumigatus infection, confirming the mNGS detection. The patient was diagnosed with mediastinal aspergillosis caused by Aspergillus fumigatus. After timely voriconazole treatment, the patient was discharged with good condition.Conclusion: Our study presented a rare case with mediastinal Aspergillus fumigatus abscess in an immunocompetent patient. As a new clinical diagnostic method, mNGS could assist timely diagnosis and precise treatment of Aspergillus infection.Keywords: mediastinal abscess, Aspergillus fumigatus, metagenomic next-generation sequencing, diagnosis, case report

Megersa Kelbesa Olika,1 Gudeta Teku Ayano,2 Tajera Tageza Ilala2 1Department of Anesthesia, Institute of Health, College of Public Health and Medical Science, Jimma University, Jimma, Oromia, Ethiopia; 2Department of Anesthesia, Faculty of Medicine, College of Medicine and Health Science, Hawassa University, Hawassa, Sidama, EthiopiaCorrespondence: Tajera Tageza Ilala, Department of Anesthesia, Faculty of Medicine, College of Medicine and Health Science, Hawassa University, Hawassa, Sidama, Ethiopia, Email tajeratageza@gmail.comBackground: A retropharyngeal abscess is a bacterial infection of the back of the throat. It rarely results in deadly complications such as mediastinitis and thoracic empyema from deep neck infections involving soft tissues of the face, arising from oropharyngeal infections, particularly dental caries. Thus, complicating retropharyngeal abscess extending to mediastinitis poses an increased risk of high mortality rate as a result of its significant invasive potential and the fact that the recognition and diagnosis must be made early, as this is usually delayed. Complicating retropharyngeal abscess increases airway compromise and difficult airway management during anesthesia. We present a 40-year-old, male patient who transferred from another primary hospital to our institution’s surgical emergency outpatient department with a complaint of neck swelling of 10 days secondary to tooth extraction. He had a complaint of dull-itching pain, localized initially to the submandibular area and subsequently involving the oropharyngeal, neck, and descending to the chest and mediastinum. He was diagnosed with a complicated retropharyngeal abscess extending to the mediastinum (mediastinitis) and thoracic empyema as a complication of odontogenic infection in origin. Besides intravenous antimicrobial therapy, deep neck incision and drainage, and thoracotomy was done under general anesthesia. After adequate venous access and the patient positioned in head-up position, premedication was given. General anesthesia with an endotracheal tube was provided with a ready tracheostomy set. Inhalational induction was conducted and laryngoscopy was performed after the adequate depth of anesthesia was achieved. We experienced anticipated difficult intubation after induction. After multiple attempts, the tracheal tube was placed correctly by using a bougie. Halothane was used for maintenance anesthesia with intermediate-acting muscle relaxant under controlled ventilation.Conclusion: On top of a detailed review of the patient’s history, physical examination, laboratory investigations, and imaging profiles; early recognition of the airway compromise from the complicated retropharyngeal abscess, and proper readiness to manage potentially challenging airway compromise, and difficult airway management during the perioperative period.Keywords: anesthesia, anesthesia management, dental infections, incision and debridement, Ludwig angina, mediastinitis, mediastinal abscess, retropharyngeal abscess, airway management, retropharyngeal abscess

International guidelines establish EUS-guided sampling as safe and accurate for the evaluation of mediastinal solid lesions, such as lymphadenopathies of unknown origin, and point out an increased risk of severe infectious complications induced by needle puncture in mediastinal cystic lesions. A retrospective case series and a systematic review documented an increased risk of mediastinal abscess formation after EUS-guided lymph nodes sampling in patients with sarcoidosis. The authors describe a case of a 38-year-old male patient with a final diagnosis of sarcoidosis, who developed a large mediastinal abscess after EUS-guided fine-needle biopsy of mediastinal lymphadenopathies. Endoscopists should be aware of the potential increased risk of severe infectious complications when sampling mediastinal lymph nodes in suspected sarcoidosis, and a strategy to minimize such risk should be pursued.

Esophageal stricture following caustic ingestion or button battery injury is common and requires serial dilations. Dilation may be augmented with triamcinolone injection. Here we present two patients, ages 3 and 1 years old, who presented with respiratory distress, and were found to have delayed abscess formation following esophageal dilation with triamcinolone injection. To our knowledge, these are the first described cases of delayed mediastinal abscess, causing respiratory distress, following esophageal dilation with triamcinolone injection for stricture after caustic injury.

Non-traumatic mediastinal abscesses are very rare in children; we can classify them into 2 types: descending mediastinitis (or mediastinitis by extension or by contiguity) complicating an otorhinolaryngological or esophageal etiology and mediastinitis generated by direct blood inoculation in a context of a septicemia or primary mediastinitis which is exceptional. We describe a case of right pleuropulmonary staphylococcal disease with bilateral mediastinal localization in a previously healthy 9-month-old infant. It was revealed by sepsis with severe respiratory distress. The germ was isolated from the pleural puncture fluid. A thoracic computed tomography was indicated due to a widening mediastinum noted on chest X-ray in addition to pleuropulmonary involvement. Thoracic computed tomography revealed a huge bilateral mediastinal abscess which was curbed thanks to right pleural drainage with adapted antibiotic therapy. Other investigations did not show any immune abnormalities in this infant. Mediastinitis represents a diagnostic and therapeutic emergency; those that are secondary to direct blood or lymphatic dissemination even very rare; should be considered in any context of severe sepsis including staphylococcus or streptococcus pneumonia. Since 1985 only 11 cases of such mediastinal abscesses have been reported. [ABSTRACT FROM AUTHOR]

Background: A retropharyngeal abscess is a bacterial infection of the back of the throat. It rarely results in deadly complications such as mediastinitis and thoracic empyema from deep neck infections involving soft tissues of the face, arising from oropharyngeal infections, particularly dental caries. Thus, complicating retropharyngeal abscess extending to mediastinitis poses an increased risk of high mortality rate as a result of its significant invasive potential and the fact that the recognition and diagnosis must be made early, as this is usually delayed. Complicating retropharyngeal abscess increases airway compromise and difficult airway management during anesthesia. We present a 40-year-old, male patient who transferred from another primary hospital to our institution's surgical emergency outpatient department with a complaint of neck swelling of 10 days secondary to tooth extraction. He had a complaint of dull-itching pain, localized initially to the submandibular area and subsequently involving the oropharyngeal, neck, and descending to the chest and mediastinum. He was diagnosed with a complicated retropharyngeal abscess extending to the mediastinum (mediastinitis) and thoracic empyema as a complication of odontogenic infection in origin. Besides intravenous antimicrobial therapy, deep neck incision and drainage, and thoracotomy was done under general anesthesia. After adequate venous access and the patient positioned in head-up position, premedication was given. General anesthesia with an endotracheal tube was provided with a ready tracheostomy set. Inhalational induction was conducted and laryngoscopy was performed after the adequate depth of anesthesia was achieved. We experienced anticipated difficult intubation after induction. After multiple attempts, the tracheal tube was placed correctly by using a bougie. Halothane was used for maintenance anesthesia with intermediate-acting muscle relaxant under controlled ventilation. Conclusion: On top of a detailed review of the patient's history, physical examination, laboratory investigations, and imaging profiles; early recognition of the airway compromise from the complicated retropharyngeal abscess, and proper readiness to manage potentially challenging airway compromise, and difficult airway management during the perioperative period. [ABSTRACT FROM AUTHOR]

Abstract Background Upper gastrointestinal (GI) bleeding is a severe acute disease of gastroenterology department. Fish bone is the most common food-related foreign body. However, fish bone piercing the esophagus, causing the mediastinal abscess that corroded the left subclavian artery, resulting delayed but high-risk massive upper gastrointestinal bleeding is very rare. Case presentation We report a 54-year-old man who was diagnosed with delayed but high-risk massive upper GI bleeding that was the result of a fish bone piercing the esophagus, causing a mediastinal abscess that corroded the left subclavian artery. He was saved effectively by early and timely multidisciplinary collaboration. Conclusion A fish bone-caused mediastinal abscess that corrodes the left subclavian artery and induces delayed but high-risk massive upper GI bleeding is very rare. In addition to routine consideration of upper GI bleeding, medical history, endoscopy and CT are helpful for achieving a diagnosis. Importantly, early and timely multidisciplinary collaboration can effectively save critically ill patients.

Mediastinal abscess, mostly resulting from esophageal perforation or cardiothoracic surgery, is a serious condition carrying high morbidity and mortality. Antibiotic therapy alone normally did not achieve a satisfactory outcome, due to poor circulation of abscess that hampers drug delivery. Surgical intervention for debridement and drainage is recommended, but it poses a high risk in patients with poor health status and could lead to various complications. Recent studies proposed endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) as an effective alternative to surgery; however, repeated TBNA procedures are usually needed for complete clearance of the lesion, thus causing increased patient suffering and medical expenses. Here, we present the first case of successful application of EBUS-guided transbronchial incision and drainage, which provides a novel, safe, and effective treatment for patient with mediastinal abscess unwilling or unsuitable to undergo surgical intervention. [ABSTRACT FROM AUTHOR]

Streptococcus dysgalactiae can lead to bacteremia in elderly individuals with underlying conditions, primarily from cellulitis. Although rare, mediastinal abscesses can develop from anatomical anomalies, post-thoracic surgery, esophageal rupture, or inflammation in the oral cavity or neck. Aorto-esophageal fistula, a life-threatening condition causing severe bleeding, typically arises from thoracic aortic aneurysms with atherosclerosis. We present a case of recurrent Streptococcus dysgalactiae bacteremia complicated by mediastinal abscess and aorto-esophageal fistula in a patient undergoing treatment for gastric cancer. Initial imaging suggested lymph node metastasis, with a diagnosis of abscess only confirmed at autopsy. Although the exact etiology of the abscess was unclear, we highly suspect the recurrent Streptococcus dysgalactiae bacteremia contributed to its development via hematogenous spread. Autopsy also revealed progression of the mediastinal abscess into the esophagus and aorta, leading to the formation of a fistula, massive hemorrhage, and ultimately, the patient's death. While uncommon, a mediastinal abscess should be recognized as a potential cause of aorto-esophageal fistula., Competing Interests: No disclosure., (© 2024 The Authors.)

We describe a 3-month-old baby who presented with a nonresolving pneumonia which failed to respond to antibiotic therapy. An underlying congenital pulmonary adenomatous malformation was suspected. On thoracotomy, she was found to have a tuberculous mediastinal abscess which was drained. Mediastinal abscess is a rare occurrence in childhood tuberculosis.

Background: Upper gastrointestinal (GI) bleeding is a severe acute disease of gastroenterology department. Fish bone is the most common food-related foreign body. However, fish bone piercing the esophagus, causing the mediastinal abscess that corroded the left subclavian artery, resulting delayed but high-risk massive upper gastrointestinal bleeding is very rare.Case Presentation: We report a 54-year-old man who was diagnosed with delayed but high-risk massive upper GI bleeding that was the result of a fish bone piercing the esophagus, causing a mediastinal abscess that corroded the left subclavian artery. He was saved effectively by early and timely multidisciplinary collaboration.Conclusion: A fish bone-caused mediastinal abscess that corrodes the left subclavian artery and induces delayed but high-risk massive upper GI bleeding is very rare. In addition to routine consideration of upper GI bleeding, medical history, endoscopy and CT are helpful for achieving a diagnosis. Importantly, early and timely multidisciplinary collaboration can effectively save critically ill patients. [ABSTRACT FROM AUTHOR]

Objective To explore the effect of negative pressure sealing drainage on the treatment of maxillofacial-neck-mediastinal infection in multiple spaces.Methods Vacuum sealing drainage (VSD) was applied in five patients with maxillofacial-neck-mediastinal infection caused by odontogenic infection accompanied by diabetes or renal failure and other systemic diseases. After extensive debridement, a negative pressure drainage sponge was placed in the pus cavity and then the wound was closed. Continuous negative pressure drainage was continued after the operation. At the same time, multidisciplinary consultation was applied to control basic diseases and, strengthen anti-inflammatory responses, and nutrition and other systemic treatments were applied.Results Four patients underwent continuous negative pressure drainage and successful removal of the negative pressure sponge after inflammatory symptoms subsided. One patient′s inflammatory symptoms became more serious after the operation, and we performed another operation to change the placement of the negative pressure sponge. All 5 patients underwent VSD with negative pressure sponge replacement ranging from 1 to 3 times during treatment. After multidisciplinary consultation, they were all cured and discharged from the hospital.Conclusion For infection of the mediastinum, maxillofacial region and neck, local treatment and systemic treatment are emphasized, as well as the treatment of infected lesions and basic diseases. Negative pressure closure and drainage technology promotes the alleviation of inflammation, and multidisciplinary combined treatment is beneficial for the control of basic diseases.

Background and Aim: Congestive heart failure (CHF) is a clinical disorder that results from cardiac dysfunction with subsequent fatal outcomes in most cases. Several diseases are incriminated in occurrence of CHF. Therefore, the aims of this study were to identify CHF etiology and associated clinical findings in 67 cows and to investigate the relationship between CHF and the other body organs using ultrasonographic examination. Materials and Methods: Sixty-seven cows affected by CHF admitted to the clinic with a history of loss of appetite, decrease in milk production, constipation, and brisket edema were thoroughly investigated clinically and ultrasonographically. In addition, ten apparently healthy cows were used as a control group. Results: Clinically, cows with CHF manifested jugular engorgement and pulsation (88.1%), brisket and/or intermandibular edema (77.6%), and muffled heart sounds (76.1%). Based on the ultrasonographic examination, traumatic pericarditis (82.1%) was the most prevalent etiology of CHF. Extracardiac etiology of CHF identified were exudative pleurisy (10.4%) and mediastinal abscesses (7.5%). Hepatomegaly (88.1%) and pleural effusion (61.2%) were the most documented consequences. Conclusion: Both cardiac and extracardiac diseases could be associated with CHF in cattle. Ultrasonographic changes in liver and pleura secondary to CHF were the most common findings. Ultrasonography is a good tool for the diagnosis of cardiac and extracardiac etiologies of CHF in cattle.

Competing Interests: None

Boerhaave syndrome (BS) is frequently reported in cases of esophageal perforation; however, there are relatively few studies on non–Boerhaave syndrome (nBS). This study clarifies the appropriate diagnosis and treatment for patients with nBS among those with esophageal ruptures. Twelve patients with esophageal ruptures who underwent surgery at our department over 14 years were classified into 2 groups: 4 in the nBS group and 8 in the BS group. Patient characteristics, surgical methods, surgical outcomes, and complications were compared between the groups. The chief complaints varied between the groups. The nBS group had significantly higher preoperative C-reactive protein (P =.007) and required 5 days (median) from onset to surgery. Moreover, the perforation diameter was significantly smaller in the nBS group than in the BS group (P =.013). Suturing of the perforation site was performed during the initial surgery in 8 BS group patients (100%) and 1 nBS group patient (25%; P =.018). Only drainage was performed during the initial surgery for 3 nBS group patients (75%). The complications did not significantly differ between the groups (P = 1.000), and no deaths were reported. The chief complaints of patients with nBS are diverse, and esophageal perforation should be cited as a differential diagnosis even in the absence of vomiting or chest pain symptoms. In the initial surgery for patients with nBS, the perforation site does not necessarily need to be closed. It is treatable by second-stage surgery or by natural closing. [ABSTRACT FROM AUTHOR]

We describe a 3-month-old baby who presented with a nonresolving pneumonia which failed to respond to antibiotic therapy. An underlying congenital pulmonary adenomatous malformation was suspected. On thoracotomy, she was found to have a tuberculous mediastinal abscess which was drained. Mediastinal abscess is a rare occurrence in childhood tuberculosis. [ABSTRACT FROM AUTHOR]

Abstract Mediastinal abscess is a rare yet emergent infectious complication of the thoracic cavity following balloon dilatation of the esophagus. Early diagnosis and management could avoid its poor outcome. A 20-year-old man with esophageal stricture underwent balloon dilatation. A mediastinal abscess developed 2 weeks after procedure. Computed tomographic chest helped in diagnosis and guiding approach of management. Surgical drainage and debridement of the abscess were performed. Surgical treatment combined with systemic antibiotics was effective, leading to remission of the abscess. Mediastinal abscess should be considered as a possible infectious complication after upper endoscopy. Computed tomographic scan is a mandatory imaging modality to enable early diagnosis. Aggressive treatment including surgical drainage combined with medical management is the treatment of choice that may prevent catastrophic outcome.

We report a case of a submucosal abscess of the esophagus that required differentiation from a mediastinal abscess. A 48-year-old man presented with a chief complaint of fever and sore throat. He did not remember swallowing a foreign body, and his oral cavity showed no signs of inflammation. Contrast-enhanced computed tomography showed a low density area with enhancement in the mediastinum, especially around the esophageal wall. We planned to perform surgical drainage with the intention of performing intraoperative endoscopy from the beginning. We performed surgical drainage through a left cervical oblique incision; however, there was no exudate obtained from the mediastinal space. Despite the reported absence of accidental ingestion of a foreign substance, intraoperative endoscopy was performed that revealed a laceration in the esophageal mucosa 24 cm from the incisors. We diagnosed it as a submucosal abscess of the esophagus and prescribed parenteral antibiotics. Submucosal abscess of the esophagus can occur even in the absence of awareness of a foreign body ingestion or oral infection. In case that the abscess was not localized clearly within the outer membrane of the esophagus, the coincidental mediastinal drainage via a cervical incision and intraoperative endoscopy seemed to be useful. [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 Eosinophilic esophagitis (EoE) is one of the most prevalent esophageal diseases and the leading cause of dysphagia and food impaction in children and young adults. EoE represents a chronic, local immune-mediated esophageal disease, characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation. Mediastinal abscess is an uncommon condition that typically appears after esophageal perforations or thoracic surgeries, usually requiring treatment for surgical intervention due to its high morbidity–mortality. Mediastinal abscess, outside these two contexts, is extremely rare. We present the case of a mediastinal abscess secondary to EoE. It is important to think about this entity when there is a mediastinal abscess without trauma or previous surgery.

Background and Aim: Congestive heart failure (CHF) is a clinical disorder that results from cardiac dysfunction with subsequent fatal outcomes in most cases. Several diseases are incriminated in occurrence of CHF. Therefore, the aims of this study were to identify CHF etiology and associated clinical findings in 67 cows and to investigate the relationship between CHF and the other body organs using ultrasonographic examination. Materials and Methods: Sixty-seven cows affected by CHF admitted to the clinic with a history of loss of appetite, decrease in milk production, constipation, and brisket edema were thoroughly investigated clinically and ultrasonographically. In addition, ten apparently healthy cows were used as a control group. Results: Clinically, cows with CHF manifested jugular engorgement and pulsation (88.1%), brisket and/or intermandibular edema (77.6%), and muffled heart sounds (76.1%). Based on the ultrasonographic examination, traumatic pericarditis (82.1%) was the most prevalent etiology of CHF. Extracardiac etiology of CHF identified were exudative pleurisy (10.4%) and mediastinal abscesses (7.5%). Hepatomegaly (88.1%) and pleural effusion (61.2%) were the most documented consequences. Conclusion: Both cardiac and extracardiac diseases could be associated with CHF in cattle. Ultrasonographic changes in liver and pleura secondary to CHF were the most common findings. Ultrasonography is a good tool for the diagnosis of cardiac and extracardiac etiologies of CHF in cattle. [ABSTRACT FROM AUTHOR]

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: Skin and soft tissue infections (SSTIs) are an increasingly common complaint in the emergency department (ED), but physical examination does not reliably identify abscesses or accurately determine which skin lesions require incision and drainage. Point-of-care ultrasound (POCUS) improves management of soft tissue skin infections by detecting occult abscess, preventing unnecessary procedures, and identifying more complex disease requiring further imaging.Case Report: Here, we report a case in which POCUS drastically changed the management of what initially appeared to be an uncomplicated superficial skin abscess but was actually a much more serious mediastinal infection. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case underscores the importance and utility of POCUS to enhance the physical examination in suspected SSTIs. Because POCUS is easy, accurate, low risk, and can change management, we recommend its consideration as a standard component of the ED work up for SSTIs. [ABSTRACT FROM AUTHOR]

No abstract available. Article truncated after 150 words. Clinical History: A 65-year-old non-smoking man with a past medical history significant only for dyslipidemia and hypertension presented to the emergency room with a 2-week complaint of intermittent, diffuse, high back pain accompanied by sweating and nausea and non-bloody emesis. The back pain does not radiate. The patient also notes that recently he has suffered from pronounced fatigue and some shortness of breath; until recently he had been an endurance athlete. Physical Examination: Physical examination was normal; in particular, the back pain was not reproducible on palpation. The patient was afebrile. Laboratory: Laboratory data were remarkable for a mildly elevated white blood cell count of 11 x 109 cells/L. Serum chemistries were within normal limits and cardiac troponins were negative. Oxygen saturation on room air was 94%. Radiography: Frontal and lateral chest radiography (Figure 1) was performed. Which of the following statements regarding the chest radiograph is most accurate? 1. ...

Desulfovibrio spp. are sulfate-reducing, anaerobic bacteria that are ubiquitously found in the environment. These organisms infrequently cause human infections, and the clinical characteristics of infection with Desulfovibrio spp. remain unclear. Here, we describe a case of Desulfovibrio desulfuricans bacteremia in an 88-year-old Japanese man with a past medical history of thoracic endovascular aortic repair (TEVAR). His chief complaint was hemoptysis for 2 weeks. A chest contrast-enhanced computed tomography demonstrated an enlarged thoracic aortic aneurysm surrounded by a ring-enhanced lesion, recognized as mediastinal abscess. Gram-negative spiral bacilli were detected in anaerobic blood culture. These bacteria could not be identified using conventional methods, but by analyzing a full base sequence of 16S rDNA, they were identified as D. desulfuricans subsp. desulfuricans . The patient underwent an emergent re-TEVAR, and the infection subsided after being treated with tazobactam/piperacillin and clindamycin, followed by metronidazole. A literature review of previous cases of D. desulfuricans bacteremia suggested that the pathogen was derived from bacterial translocation from the intestine in most cases. Desulfovibrio infection is presumably underestimated due to its infrequency, indolent growth, and difficulty in identification. Desulfovibrio spp. should be suspected when spiral rods are observed in anaerobic culture, and molecular analysis is required for accurate species-level differentiation of the pathogens. To better understand the pathogenicity of these fastidious organisms, further cases based on the exact bacterial identification should be investigated. [ABSTRACT FROM AUTHOR]

Introduction: Deep cervical abscesses have different clinical presentations, but when associated with mediastinitis, there is a significant increase in mortality. Objectives: To report the excellent clinical evolution of a potentially fatal disease through an effective and agile clinical-surgical approach. Case report: Male, 69 years old, hypertensive, diabetic and alcoholic, with a 20-day complaint of significant odynophagia and unmeasured fever, associated with loss of 15 kilograms in the period. Patient had already used Azithromycin, Amoxicillin and Levofloxacin, without improvement. On physical examination, he was in good general condition, with points of hyperemia in the oropharynx region, restriction of cervical mobility and nasofibroscopy with retropharyngeal bulging. Laboratory tests without leukocytosis and reactive C protein of the 45,25. Computed tomography showed a purulent collection involving the retropharyngeal space extending to the infracarinal mediastinum measuring 23.8 x 3.8 x 2.0 cm. Hospitalization was performed for administration of ceftriaxone 2000 mg 1x/day associated with clindamycin 600 mg 6/6 hours empirically, in addition to drainage of retropharyngeal and mediastinal abscess, in less than 24 hours of hospitalization. Six number 2 penrose drains were positioned in the cervical region, which were removed on the third day of hospitalization. The patient remained hospitalized for 10 days, being discharged in excellent clinical and laboratory conditions. Conclusion: Despite the severity of the case, emergency medical care was the main factor in the evolution clinical and laboratory evolution of the reported case.. [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.

The loss of vocal function is observed after total laryngectomy. Tracheoesophageal voice prosthesis placement is used among voice rehabilitation techniques, that is introduced by Singer and Blom since 1980. Tracheoesophageal puncture is performed during this procedure. Some complications such as hemorrhage, esophageal perforation, cervical vertebral fracture and mediastinitis can be observed after puncture formation. We report mediastinal abscess formation after tracheoesophageal puncture in a patient with diabetes mellitus treated with radiotherapy after total laryngectomy. Early diagnosis and treatment is important in mediastinal abscess, which has 10-35% high morbidity and mortality rate. Surgical drainage takes place in treatment of mediastinal abscess. However, we report management of mediastinal abscess with medical treatment of our case with his clinical presentation.