Descending necrotizing mediastinitis following dental extraction. Radiological features and surgical treatment considerations.

Descending necrotizing mediastinitis (DNM) following dental extraction is an extremely serious infection with a high mortality rate. Oral infection may rapidly descend into the mediastinum across the retropharyngeal and retrovisceral spaces. Once established, mediastinitis is rapidly followed by sepsis and death. If DNM is suspected cervical and thoracic CT must be carried out urgently. After this, prompt control of the upper airway with tracheostomy, aggressive surgical debridement of the deep cervical spaces and mediastinum, and intravenous broad spectrum antibiotic therapy are mandatory. The present paper reports two new cases of DNM following dental extraction, and focuses on radiological features of abscess progression through the cervical spaces down into the mediastinum.

[Pulmonary sequestrations: presentation of eight cases]. / Secuestros pulmonares: presentación de 8 casos.

INTRODUCTION: Lung sequestration is a pathologically isolated pulmonary parenchyma, with its own arterial vascularisation. AIMS: A descriptive-retrospective study of patients of the La Princesa University Hospital, Madrid. MATERIAL AND METHODS: The characteristics of patients admitted to the La Princesa University Hospital Thoracic Surgery Unit during 1996-2008, were analysed. RESULTS: Of the 500 patients, 8 had histopathology confirmation, of which 5 were women. There was respiratory infection in 7 patients, with 4 in the lower right lobe. The intralobar variant was diagnosed in 7 patients. The systemic vascularisation came from the thoracic aorta in five cases. A standard posterolateral thoracotomy with lobectomy was performed in 5 patients. There was no morbidity or mortality. It was more common in women, in lower lobes and similar in both hemithorax; 3. The most common clinical symptom was the respiratory infection; 4. The diagnosis was made with imaging tests.