Descending necrotizing mediastinitis: A conservative approach

March 18, 2014
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Descending necrotizing mediastinitis (DNM) is a now-rare complication of dental and pharyngeal infections. Reports in the literature have emphasized the need for early, aggressive surgical intervention. We present a case of DNM with bilateral empyemas that arose secondary to a perforated pharyngeal abscess. The patient was successfully managed conservatively with intravenous antibiotics and intercostal drainage. We conclude that conservative management with antibiotics and image-guided percutaneous pleural drainage may be initially appropriate for the stable patient.


Descending necrotizing mediastinitis (DNM) is a rare complication of oral and pharyngeal infections in the postantibiotic era. When it does occur, the prognosis is poor, with a reported mortality rate of about 40%.1-4

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