Endo et al classified necrotizing mediastinitis arising from cervical necrotizing fasciitis. This is a life-threatening infection which requires aggressive management. The authors are from Jichi Medical School in Tochigi, Japan.
Patient selection: cervical necrotizing fasciitis extending down into the mediastinum
Location
Terms for Descending Necrotizing Mediastinitis
Type
upper mediastinum above the carina and aortic arch
localized, superior
I
lower anterior mediastinum below the aortic arch
diffuse, inferior
IIA
lower anterior and posterior mediastinum below the aortic arch
diffuse, inferior
IIB
where:
• Posterior descending infection without anterior involvement would probably be classed as Type IIB.
This is an anatomic classification which can help guide drainage of the abscess.
Type
Drainage
Type I
transcervical
Type IIA
transcervical AND anterior mediastinum (via subxyphoidal incision or sternotomy)
Type IIB
as for Type IIA AND posterior thoracotomy
Complications:
(1) necrotizing empyema
(2) thymic necrosis
(3) shock
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