Descending Necrotizing Mediastinitis (DNM) associated with an oropharyngeal abscess can be classified using the scheme of Endo et al. The authors are from Jichi Medical School in Tochigi, Japan.
Types seen on chest CT:
(1) Type I
(2) Type IIA
(3) Type IIB
Extent
Involvement
Type
localized
upper mediastinal space above the carina
I
diffuse
lower anterior mediastinum (below the carina)
IIA
diffuse
lower anterior and posterior mediastinum
IIB
The type of DNM helps to determine the appropriate approach required for draining the abscesses.
Type
Approach for Drainage
I
may not require aggressive mediastinal drainage
IIA
subxiphoidal
IIB
complete mediastinal drainage wit debridement via thoracotomy
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