• Journal of Chest Surgery
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• v.31 no.7
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• pp.722-724
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• 1998

Acute mediastinitis and subsequent graft infection following aorta surgery poses a difficult problem, as infected synthetic material must be completely removed for resolution of infection. Here we report a case of successful management of acute mediastinitis following hemiarch replacement for acute aortic dissection with omental flap transfer leaving infected graft in situ.

• Journal of Chest Surgery
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• v.40 no.5 s.274
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• pp.388-391
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• 2007

Subclavian catheter insertion is now widely used because of its technical feasibility and effectiveness, but some complications related to this procedure have been noted. We present here a rare surgical case of post central line insertion mediastinitis with no mechanical complication.

• Tuberculosis and Respiratory Diseases
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• v.44 no.5
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• pp.1146-1157
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• 1997

Fibrosing mediastinitis is a rare disease which is characterized by excessive fibrosis of mediastinum and symptoms caused by compression and obstruction of mediastinal structures. Although the pathogenesis of this disease is unknown, granulomatous infection is cinsidered to be the most common cause of this disease. Histoplasmosis is the most common etiology, especially in the endemic areas in United States. Tuberculosis is another etiology of fibrosing mediastinitis. We experienced two cases of fibrosing mediastinitis associated with tuberculous infection.

• Tuberculosis and Respiratory Diseases
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• v.52 no.3
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• pp.278-282
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• 2002

A 68-year-old woman was admitted after suffering facial edema with neck vein engorgement for approximately 2 months. A chest X-ray showed a mild widening of the superior mediastinum and a luminal obliteration of the superior vena cava(SVC) was noted on a computed tomograph. Venography showed that both subclavian veins were obstructed at the level of the proximal clavicle with a nonvisualization of the SVC. The SVC, both the innominate and the left internal jugular veins were completely obstructed with extensive cord-like fibrotic changes despite the absence of mediastinal involvement. The microscopic features showed a chronic granulomatous inflammation with a fibrosis minimally invading the mediastinal fat, which is consistent with fibrosing mediastinitis.

• Journal of Chest Surgery
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• v.40 no.10
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• pp.711-714
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• 2007

Phlegmonous esophagitis is a disorder in which bacterial infection occurs in the submucosal and muscular layers of the esophagus. This malady is very rare and it is usually associated with high mortality. A 69-year-old male was admitted with chest pain and fever he'd experienced for 7 days. The chest computerized tomography scan revealed mediastinal widening, circumferential esophageal thickening, an air shadow along the esophagus and right pleural effusion. Drainage and debridement of the mediastinum and primary repair of the perforated esophageal muscular layer through a right thoracotomy was done immediately. Further surgical treatment was not performed. He had a good oral intake without dysphagia or esophageal leakage at discharge.

• Journal of Chest Surgery
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• v.41 no.1
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• pp.82-88
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• 2008

Background: Descending necrotizing mediastinitis (DNM) is a serious disease originating in odontogenic or oropharyngeal infection with high mortality despite adequate antibiotics and aggressive surgery. We analyzed results of treatment for DNM. Material and Method: We studied 8 cases diagnosed as DNM from 1998 to 2007. All patients received emergent surgical drainage and debridement with broad spectrum antibiotics just after diagnosis. Antibiotics were changed after bacterial susceptibility testing. The surgical approach included 2 cases of cervicotomy, 6 cases of cervicotomy, and a thoracotomy. Result: The interval between symptom onset and hospitalization was $4.6{\pm}1.8$ days ($1{\sim}9$ day). DNM originated in 4 cases of odontogenic infection (50%), 2 cases of oropharyngeal infection (25%), and 2 cases of unknown origin (25%). Causative organisms were found in 6 cases; Streptococcus in 4 cases, Staphylococcus in 1 case, and Klebsiella in 1 case. The Endo DNM classification was type I (2 cases), IIA (3 cases), and IIB (3 cases). The incidence of thoracotomy was 75%. The surgical mortality rate was 25% (2/8). The cause of death was multiple organ failure caused by septic shock. All mortality cases received only cervicotomy and aggravated infections after initial drainage. Conclusion: Early diagnosis, immediate surgical drainage, and adequate antibiotics, including covered anaerobes, are required. Thoracotomy should be performed with cervicotomy even for localized DNM.

• Journal of Chest Surgery
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• v.33 no.8
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• pp.693-696
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• 2000

Descending necrotizing mediastinitis(DNM) is one of the most lethal form of mediastinitis originating from an oropharyngeal infection. It requires an early and aggressive sugical treatment, but the operative approach and optimal form of mediastinal drainage remains controversial. We report a case of DNM in a 45-year-old male who underwent right cervicomediastinotomy to drain the deep neck space, upper mediastinum and anterior mediastinal drainage was accomplished through a subxiphoid approach. After this procedure, he steadily improved and was dischrged on hospital day 36. We report this case with a brief review of the literature.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1979.05a
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• pp.9.1-10
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• 1979

The authors have recently observed a case of Ludwig's angina with forming mediastinal fistula & pneumonia. The Ludwing's angina is the cellulitis of the mouth floor and neck, ie, of the sublingual space. The suppurative inflammation of this space develops from dental infection, and can also develop from ulceration or inflammation of the mouth floor and the tongue base, lingual tonsillitis or salivary calculi. The main causes are characterized as mixed infection which hemolytic streptococcus and staphylococcus are considered to be pathognomic organisms. It may be followed as complications of mediastinal extension, parapharyngeal extension and laryngeal edema. This is the report on this case with literature review.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1981.05a
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• pp.8.5-9
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• 1981

Foreign body in the esophagus is not uncommon in the otolaryngological field and esophageal perforation followed by mediastinitis is one of the most serious complications. Authors had experienced such case developed in 69 year old female patient. This woman swallowed a piece of sharp glass accidentally. Severe pain and swelling around the neck developed after ingestion. Marked subcutaneous emphysema was noted on first examination. By esophagoscopy, longitudinal laceration at right lateral wall of the cervical esophagus was noted and a lot of food debries were removed through this perforation, but foreign body could not be found. On third hospital day, patient complained chest pain and dyspnea. Mediastinal widening was noted on chest P-A. Tracheostomy was performed on next day and neck swelling decreased much. In spite of massive antibiotics, mediastinal abscess was developed and external drainage was performed on 15th hospital day. She was discharged on 38th hospital day with marked improvement and recovered completely on follow-up study. Still, we do not know where the foreign body is located.

• Korean Journal of Bronchoesophagology
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• v.11 no.2 s.22
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• pp.24-31
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• 2005