Descending Necrotizing Mediastinitis, a Dreaded Complication of Acute Tonsillitis

Authors

  • Ma. Stephanie C. Go Department of Otorhinolaryngology-Head & Neck Surgery Quezon City General Hospital and Medical Center
  • Emmanuel Tadeus S. Cruz Department of Otorhinolaryngology-Head & Neck Surgery Quezon City General Hospital and Medical Center; Department of Otorhinolaryngology-Head & Neck Surgery Manila Central University-Filemon D. Tanchoco Medical Foundation

DOI:

https://doi.org/10.32412/pjohns.v30i2.349

Keywords:

Acute tonsillophraryngitis, tonsillitis, mediastinitis, descending necrotizing mediastinitis

Abstract

Objective: To report a case of acute tonsillitis that subsequently developed descending necrotizing mediastinitis, and to discuss the signs and symptoms, differential diagnosis, pathophysiology, diagnostic criteria, ancillary procedures and management.

 

Methods:

            Design: Case Report

            Setting: Tertiary private and government hospital

            Patient: One

 

Results:  A 36-year-old woman was admitted with a 2-day history of sore throat and a diagnosis of acute exudative tonsillitis. She complained of sore throat accompanied by dyspnea, neck and chest pain which rapidly progressed to mediastinitis. She was transferred to a tertiary government hospital where video assisted thoracoscopic surgery with bilateral deloculation, mediastinoscopy and bronchoscopy revealed purulent discharge from the right main stem bronchus with multiloculated effusion in the left lung and posterolateral loculated effusion in the right lung. Her condition improved and she was discharged after a month of antibiotic therapy.

 

Conclusion:  Acute tonsillitis seldom leads to a life-threatening complication such as mediastinitis. Descending necrotizing mediastinitis develops when acute tonsillar infection progresses and descends to the mediastinum. It is a surgical emergency which requires mediastinal drainage, thoracotomy and long-term antimicrobials. Clinicians who manage oropharyngeal infections should be aware of this rare but lethal complication which may occur even in non-immunocompromised individuals.

 

Keywords: Acute tonsillophraryngitis, tonsillitis, mediastinitis, descending necrotizing mediastinitis.     

 

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Published

2015-12-02

How to Cite

1.
Go MSC, Cruz ETS. Descending Necrotizing Mediastinitis, a Dreaded Complication of Acute Tonsillitis. Philipp J Otolaryngol Head Neck Surg [Internet]. 2015 Dec. 2 [cited 2024 Nov. 21];30(2):38-42. Available from: https://pjohns.pso-hns.org/index.php/pjohns/article/view/349

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