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                            2 => "L&#46; Hern&#225;ndez P&#233;rez"
                            3 => "A&#46; Trivi&#241;o Ram&#237;rez"
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Clinical Image
An Unusual Case of Descending Necrotizing Mediastinitis
Un caso raro de mediastinitis necrosante descendente
Alfonso López-Frías López-Jurado
Corresponding author
alfonsolflj@gmail.com

Corresponding author.
, Inés Pecharromán de las Heras, Josefa Pérez Templado Ladrón de Guevara
Servicio de Radiodiagnóstico, Hospital Universitario Ramón y Cajal, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We report the case of a 63-year-old woman with diabetes&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a> who presented in the emergency department with painful swallowing and inability to swallow solids that was diagnosed as acute tonsillitis&#46; She received a 10-day course of azithromycin due to a history of penicillin allergy&#46; In view of her severe clinical picture &#40;deterioration of her general status associated with mucocutaneous pallor&#41; and laboratory results &#40;leukocytosis and increased C-reactive protein&#41;&#44; we decided to perform a cervical and thoracic CT with intravenous contrast to rule out complications associated with tonsillitis&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The study revealed a small abscess in the sinus of the right palatine tonsil &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>a&#41; communicating with the ipsilateral visceral infrahyoid space through a descending fistula crossing the parapharyngeal space&#46; A collection then formed&#44; following a pretracheal route&#44; crossing the midline in the fat plane underlying the superficial layer of the deep cervical fascia&#44; then taking a perithyroidal route&#44; and returning to enter the chest through the upper left thoracic inlet &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>b&#41;&#46; It reached its maximum dimension at the entry point&#44; presenting gas bubbles&#44; and took on a tubular form in the middle and posterior mediastinum&#44; almost completely surrounding the descending thoracic aorta along its entire length until the thoracoabdominal transition &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>c and d&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">This case is unique in 2 ways&#58; the unusual path followed by the collection while making its way toward the chest through the anterior cervical planes&#44; when the deep planes are the more common route<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">2</span></a> &#40;retropharyngeal route&#41;&#59; and access of the collection to the middle and posterior mediastinum&#44; when the anterior mediastinum would be more expected&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; L&#243;pez-Fr&#237;as L&#243;pez-Jurado A&#44; Pecharrom&#225;n de las Heras I&#44; P&#233;rez Templado Ladr&#243;n de Guevara J&#46; Un caso raro de mediastinitis necrosante descendente&#46; Arch Bronconeumol&#46; 2019&#59;55&#58;435&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;a&#41; Cervical CT in axial plane at the level of the epiglottis&#44; showing an abscess measuring millimeters in the lower part of the right palatine tonsil &#40;arrow&#41;&#59; &#40;b&#41; cervical CT in axial plane at the level of the thyroid&#44; revealing a collection with gas that surrounds the left thyroid lobe in an anterior direction&#44; and then subsequently progresses in an posterior direction&#44; passing into the chest through the upper left thoracic inlet &#40;arrow&#41;&#59; &#40;c&#41; chest CT in axial plane at the level of the carina&#58; the collection is displayed in the middle and posterior mediastinum surrounding the thoracic aorta by more than 180&#176;&#46; This acts as a mass on the middle esophagus &#40;asterisk&#41;&#59; and &#40;d&#41; chest CT oblique sagittal plane&#44; showing the collection extending along the entire length of the descending thoracic aorta&#46; A small amount of pleural effusion can be observed&#46;</p>"
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      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
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            0 => array:3 [
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              "etiqueta" => "1"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mediastinitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "P&#46; Mart&#237;nez Vallina"
                            1 => "D&#46; Espinosa Jim&#233;nez"
                            2 => "L&#46; Hern&#225;ndez P&#233;rez"
                            3 => "A&#46; Trivi&#241;o Ram&#237;rez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2011"
                        "volumen" => "47"
                        "numero" => "Suppl&#46; 8"
                        "paginaInicial" => "S32"
                        "paginaFinal" => "S36"
                      ]
                    ]
                  ]
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              ]
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            1 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nonvascular&#44; nontraumatic mediastinal emergencies in adults&#58; a comprehensive review of imaging findings"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "V&#46;S&#46; Katabathina"
                            1 => "C&#46;S&#46; Restrepo"
                            2 => "S&#46; Martinez-Jimenez"
                            3 => "R&#46;F&#46; Riascos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1148/rg.314105177"
                      "Revista" => array:6 [
                        "tituloSerie" => "Radiographics"
                        "fecha" => "2011"
                        "volumen" => "31"
                        "paginaInicial" => "1141"
                        "paginaFinal" => "1160"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21768244"
                            "web" => "Medline"
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                    ]
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                ]
              ]
            ]
          ]
        ]
      ]
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    "agradecimientos" => array:1 [
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        "identificador" => "xack420386"
        "titulo" => "Acknowledgements"
        "texto" => "<p id="par0020" class="elsevierStylePara elsevierViewall">We thank Luis Gorospe Sarasua and Agustina Vicente B&#225;rtulos of the Radiodiagnostic Department&#44; Hospital Universitario Ram&#243;n y Cajal&#44; Madrid&#44; Spain&#46;</p>"
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Article information
ISSN: 15792129
Original language: English
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