Asunto(s)
Vesícula/cirugía , Neumonectomía/efectos adversos , Aspergilosis Pulmonar/microbiología , Vesícula/congénito , Vesícula/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Aspergilosis Pulmonar/diagnóstico , Aspergilosis Pulmonar/cirugía , Reoperación , Toracotomía , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
BACKGROUND: Descending necrotizing mediastinitis is a dreadful disease with a high mortality rate, particularly when below the tracheal carina. This study describes the epidemiologic, clinical, and paraclinical features of patients treated for this condition. METHODS: We performed a single-center retrospective descriptive review of 60 patients with descending necrotizing mediastinitis below the tracheal carina, who were treated during a 7-year period, the largest study in the last 50 years. Demographic, clinical, paraclinical, and therapeutic variables were analyzed. RESULTS: 43 (71.7%) patients were male. The mean age was 41.2 ± 14.7 years. Mean hospital length of stay was 25.0 ± 19.8 days. Comorbidities were present in 46.7% of patients, diabetes mellitus being the most common. Odontogenic infections (45%) were the most frequent source of descending necrotizing mediastinitis. Cultures showed Gram-negative bacilli in 68.3%, Gram-positive cocci in 38.3%, and fungi in 6.7%. Mortality was 35% (21 patients); risk factors for mortality were age (>35 years), diabetes mellitus among other comorbidities, and associated complications. CONCLUSIONS: In this low socioeconomic status patient population, descending necrotizing mediastinitis below the carina causes high morbidity and mortality, the latter particularly associated with age, complications, diabetes mellitus and other comorbidities.
Asunto(s)
Mediastinitis , Adulto , Factores de Edad , Anciano , Terapia Combinada , Comorbilidad , Femenino , Humanos , Tiempo de Internación , Masculino , Mediastinitis/diagnóstico , Mediastinitis/microbiología , Mediastinitis/mortalidad , Mediastinitis/terapia , México/epidemiología , Persona de Mediana Edad , Necrosis , Grupo de Atención al Paciente , Estudios Retrospectivos , Factores de Riesgo , Factores Socioeconómicos , Factores de Tiempo , Resultado del TratamientoRESUMEN
A 58-year-old man with a history of Ludwig's angina was admitted with a spinal cord abscess at the level of C2-T1 and associated osteomyelitic destruction of vertebral bodies, spinal cord compression, and secondary quadriparesis, followed by descending mediastinitis. A right posterolateral thoracotomy and a cervicotomy drained purulent exudates. A tracheostomy was performed, and the patient was discharged after 84 days.
Asunto(s)
Absceso/microbiología , Infecciones Bacterianas del Sistema Nervioso Central/microbiología , Angina de Ludwig/microbiología , Mediastinitis/microbiología , Enfermedades de la Médula Espinal/microbiología , Infecciones Estafilocócicas/microbiología , Absceso/diagnóstico , Absceso/cirugía , Antibacterianos/uso terapéutico , Infecciones Bacterianas del Sistema Nervioso Central/diagnóstico , Infecciones Bacterianas del Sistema Nervioso Central/cirugía , Drenaje , Humanos , Angina de Ludwig/diagnóstico , Imagen por Resonancia Magnética , Masculino , Mediastinitis/diagnóstico , Mediastinitis/cirugía , Persona de Mediana Edad , Necrosis , Osteomielitis/etiología , Cuadriplejía/etiología , Compresión de la Médula Espinal/etiología , Enfermedades de la Médula Espinal/diagnóstico , Enfermedades de la Médula Espinal/cirugía , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/terapia , Staphylococcus epidermidis/aislamiento & purificación , Toracotomía , Factores de Tiempo , Tomografía Computarizada por Rayos X , Traqueostomía , Resultado del TratamientoRESUMEN
Descending necrotizing mediastinitis is usually associated with cervical or odontogenic infections. We describe a patient with blunt trauma to the chest 2 years earlier, and a slowly developing chest wall hematoma 18 months prior to admission, complicated by chronic sternoclavicular joint osteomyelitis, eventually leading to descending mediastinitis. Thoracotomy with drainage of the mediastinal spaces and multiple procedures for the sternoclavicular joint infection were successful. The rarity of this association and undefined optimal management prompted this report.
Asunto(s)
Infecciones por Escherichia coli/microbiología , Mediastinitis/microbiología , Osteomielitis/microbiología , Infecciones Estafilocócicas/microbiología , Articulación Esternoclavicular/microbiología , Antibacterianos/uso terapéutico , Terapia Combinada , Desbridamiento , Drenaje , Infecciones por Escherichia coli/diagnóstico , Infecciones por Escherichia coli/terapia , Femenino , Humanos , Mediastinitis/diagnóstico , Mediastinitis/terapia , Persona de Mediana Edad , Necrosis , Osteomielitis/diagnóstico , Osteomielitis/terapia , Factores de Riesgo , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/terapia , Irrigación Terapéutica , Toracotomía , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
A 22-year-old man with varicella had associated cervical enlargement, right upper thoracic anterior and suprascapular cellulitis, and mediastinitis. A tracheostomy, right posterolateral thoracotomy, cervicotomy, and upper thoracic fasciotomy were performed 14 h after admission, draining purulent exudates from all sites. The patient was discharged on postoperative day 22.
Asunto(s)
Celulitis (Flemón)/cirugía , Varicela/complicaciones , Mediastinitis/cirugía , Celulitis (Flemón)/etiología , Drenaje , Humanos , Masculino , Mediastinitis/diagnóstico por imagen , Mediastinitis/etiología , Radiografía , Toracotomía , Traqueostomía , Resultado del Tratamiento , Adulto JovenRESUMEN
We report the case of a 42-year old diabetic male presenting with erythema of the neck and anterior right thoracic region secondary to the application of an ointment derived from rattlesnakes, progressing to a full-blown necrotizing fasciitis in a short period of time, with associated mediastinitis, thrombocytopaenia and sepsis. The patient died despite aggressive multidisciplinary medical and surgical treatment. We present this case due to the unusual aetiology and fulminating course.
Asunto(s)
Venenos de Crotálidos/efectos adversos , Fascitis Necrotizante/inducido químicamente , Mediastinitis/etiología , Adulto , Venenos de Crotálidos/administración & dosificación , Desbridamiento , Fascitis Necrotizante/complicaciones , Fascitis Necrotizante/diagnóstico , Estudios de Seguimiento , Humanos , Masculino , Mediastinitis/diagnóstico , Mediastinitis/cirugía , Pomadas/efectos adversos , Pared Torácica , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Approximately 25% of carcinoid tumors develop in the respiratory system. Neuroendocrine carcinoids represent ~5% of all mediastinal tumors and 1-5% of all intrathoracic neoplasms. They contain numerous neurosecretory granules that synthesize, store and release neurohumoral substances that can induce the carcinoid syndrome. CLINICAL CASE: A 21-year-old male presented with a rapidly progressive paraneoplastic syndrome unleashed by an acute urethritis. Two left mediastinal masses were identified and resected. Postoperative evolution has been uneventful during the first year. CONCLUSIONS: We emphasize the importance of early detection of primary and satellite lesions of these tumors including neurohumoral markers and PET/CT scans as in this case, as well as the participation of a multidisciplinary team.