Single article

DOI: 10.47026/2413-4864-2022-2-9-14

Sidorov I.A., Dobrov A.V., Karzakova L.M.

Descending Purulent Mediastinitis: Features of the Course, Diagnosis and Treatment

Keywords: purulent mediastinitis, trans-cervical mediastinotomy, transthoracic drainage

Descending purulent mediastinitis is a rare but a life-threatening disease. The absence of characteristic symptoms and a rare incidence of descending purulent mediastinitis in clinical practice are the main reasons for the late diagnosis of this disease and high mortality due to it. In our practice, we have observed 21 cases of descending purulent mediastinitis. The aim of the study is to characterize the features of the course, methods of diagnosis and treatment for descending purulent mediastinitis used in the setting of a multidisciplinary hospital. The focus of infection was detected in 18 patients (85.7%). In most cases, the etiological factor was odontogenic infection – in the area of the second and third mandibular molars (52.3%). The results of bacterial culture test showed that streptococci (Strepto coccus viridans, β-hemolytic streptococci) and staphylococci (Staphylococcus aureus, hemolytic staphylococci) were most often plated from infected foci. In the subgroup of deceased patients, who made up 47.6% of the total number of patients, mixed cultures of microorganisms containing Staphylococcus aureus were more often detected during bacterial culture tests. These patients had to change groups of antibiotics several times. The unfavorable outcome of descending purulent mediastinitis may be due to a delay in the use of transthoracic mediastinal drainage. Early drainage of the neck and mediastinum, timely thoracotomy should be considered as the treatment method of choice in patients with descending purulent mediastinitis.


  1. Sidorov I.A., Volkov A.N., Kudryashov S.I., Karzakova L.M. Osobennosti citokinovogo profilya pri tyazhelyh gnojno-vospalitel’nyh zabolevaniyah lica i shei [Some features of cytokine profile in severe pyoinflammatory diseases of face and neck]. Medicinskaya immunologiya, 2012, vol. 14, no. 4-5, pp. 433–438.
  2. Arruda J.A., Figueiredo E., Álvares P., Silva L., Silva L., Caubi A., Silveira M., Sobral A.P. Cervical necrotizing fasciitis caused by dental extraction. Case Reports in Dentistry, 2016, vol. 2016, p. 1674153. DOI: 10.1155/2016/ 1674153.1674153.
  3. de Figueiredo E.L., Aires C., Neres B., de Araújo B.L., de Arruda J., de Holanda Vasconcellos R.J. Persistent Necrotizing Mediastinitis after Dental Extraction. Case reports in dentistry2019, vol. 2019, p. 6468348. DOI: 10.1155/2019/6468348.
  4. Fukuchi M., Suzuki O., Nasu D., Koizumi K., Muta Y., Imaizumi H., Ishiguro T., Kumagai Y., Ishibashi K., Mochiki E., Ishida H. Descending Necrotizing Mediastinitis Treated with Tooth Extractions following Mediastinal and Cervical Drainage. Case reports in gastroenterology, 2015, 9, no. 3, pp. 311–316. DOI: 10.1159/000441386.
  5. Gehrke T., Scherzad A., Hagen R., Hackenberg S. Deep neck infections with and without mediastinal involvement: treatment and outcome in 218 patients. European Archives of Oto-Rhino-Laryngology, 2022, vol. 279, no. 3, pp. 1585–1592. DOI: 10.1007/ s00405-021-06945-9.
  6. Hidaka H., Yamaguchi T., Hasegawa J., Yano H., Kakuta R., Ozawa D., Nomura K., Katori Y. Clinical and bacteriological influence of diabetes mellitus on deep neck infection: systematic review and metaanalysis. Head, Neck, 2015, 37, no. 10, pp. 1536–1546. /hed.23776.
  7. Misthos P., Katsaragakis S., Kakaris S., Theodorou D., Skottis I. Descending necrotizing anterior mediastinitis: analysis of survival and surgical treatment modalities. Journal of oral and maxillofacial surgery. 2007, 65, no. 4, pp. 635–639. DOI:10.1016/j.joms.2006.06.287.
  8. Prado-Calleros H.M., Jiménez-Fuentes E., Jiménez-Escobar I. Descending necrotizing mediastinitis: systematic review on its treatment in the last 6 years, 75 years after its description. Head Nec, 2016, 38(S1), pp. 2275–2283. DOI: 10.1002/hed.24183.
  9. Qu L., Liang X., Jiang B., Qian W., Zhang W., Cai X. Risk factors affecting the prognosis of descending necrotizing mediastinitis from odontogenic infection. Journal of Oral and Maxillofacial Surgery, 2018; 76, no. 6, pp. 1207–1215. DOI: 10.1016/j.joms.2017.12.007.
  10. Sakai T., Matsutani N., Ito K., Mochiki M., Mineda J., Shirai S., Kanaoka R., Yamauchi Y., Saito Y., Sakao Y., Kawamura M. Deep cervical and paratracheal drainage for descending necrotizing mediastinitis. Asian cardiovascular and thoracic annals, 2020, vol. 28, no. 1, 29–32. DOI: 10.1177/0218492319896515.
  11. Scaglione M., Pinto A., Romano S., Giovine S., Sparano A. Determinig optimum management of descending necrotizing mediastinitis with CT; experience with 32 cases. Emergency radiology, 2005, vol. 11, pp. 275–280. DOI:10.1007/s10140-005-0422-3.
  12. Sideris G., Sapountzi M., Malamas V., Papadimitriou N., Maragkoudakis P., Delides A. Early detecting cervical necrotizing fasciitis from deep neck infections: A study of 550 patients. European archives of oto-rhino-laryngology, 2021, vol. 278, pp. 4587–4592. DOI: 10.1007/s00405-021-06653-4.
  13. Taylor M., Patel H., Khwaja S., Rammohan K. Descending cervical mediastinitis: the multidisciplinary surgical approach. European archives of oto-rhino-laryngology, 2019, vol.276,7, pp. 2075–2079.
  14. Tsunoda R., Suda S., Fukaya T., Saito K. Descending necrotizing mediastinitis caused by an odontogenic infection: a case report. Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons, 2000, vol. 58, no. 2, 240–242. DOI: 10.1016/s0278-2391(00)90348-3.
  15. Vieira F., Allen S.M., Stocks R.M., Thompson J.W. Deep neck infection. Otolaryngologic clinics of North America, 2008, vol. 41, pp. 459–483. DOI: 10.1016/j.otc.2008.01.002.
  16. Whitesides L., Cotto-Cumba C., Myers R.A. Cervical necrotizing fasciitis of odontogenic origin: A case report and review of 12 cases. Journal of oral and maxillofacial surgery, 2000, vol. 58, pp. 144–151. DOI: 10.1016/S0278-2391(00)90327-6.
  17. Wu P., Ye F., Zhang Z., Zhang L., Lin H., Ye F., Zhuang Z., Lin R., Ye M., Lin X., Li H. Descending Necrotizing Mediastinitis: Analysis of 9 Cases in Our Hospital. Ear, nose, and throat journal, 2021, vol. 100, no. 5, pp. 350–353. DOI:10.1177/0145561320933964.
  18. Ye R.H., Yang J.C., Hong H.H., Mao Y.P., Zhu Y.H., Cao Y., Wang Z. Descending necrotizing mediastinitis caused by Streptococcus constellatus in an immunocompetent patient: case report and review of the literature. BMC pulmonary medicine, 2020, vol. 17, no. 20(1), pp. 43. DOI:10.1186/s12890-020-1068-1063.

About authors

Sidorov Ivan А.
Doctor of Medical Sciences, Professor of the Department of Internal Diseases, Chuvash State University, Russia, Cheboksary (; ORCID:
Dobrov Aleksey V.
Head of the Department of Thoracic Surgery, Republican Clinical Hospital, Russia, Cheboksary (; )
Karzakova Luiza M.
Doctor of Medical Sciences, Professor, Head of Internal Diseases Department, Chuvash State University, Russia, Cheboksary (; ORCID:

Article link

Sidorov I.A., Dobrov A.V., Karzakova L.M. Descending Purulent Mediastinitis: Features of the Course, Diagnosis and Treatment [Electronic resource] // Acta medica Eurasica. – 2022. – №2. P. 9-14. – URL: DOI: 10.47026/2413-4864-2022-2-9-14.