CTICasesDescending Necrotizing Mediastinitis
Imaging findings
CT of the neck and chest shows a large parapharyngeal abscess in the neck. Over a six-day period, a follow-up chest CT shows progression of fluid, inflammatory fat stranding, and gas collections behind the trachea, extending inferiorly into the posterior and superior mediastinum. Culture of the fluid grows Streptococcus anginosus.
Key takeaways
Descending necrotizing mediastinitis is a severe, life-threatening infection of the mediastinum that descends from a primary oropharyngeal or deep neck infection (such as a retropharyngeal or parapharyngeal abscess) along the cervical fascial planes. Streptococcus anginosus (part of the Streptococcus milleri group) is a highly aggressive, pus-forming pathogen commonly implicated in deep tissue abscesses and mediastinitis. Management requires urgent surgical drainage of both the neck and mediastinum.
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