Acute suppurative mediastinitis of oropharyngeal origin in childhood: case report and review of the literature

Abstract

In the era of modern antibiotics, acute suppurative mediastinitis (ASM) without previous surgical intervention or esophageal perforation is a rare infectious complication in childhood. Once infected, the mediastinum offers very little resistance to the spread of infection, due in part to a lack of efficient anatomic barriers. Thus, ASM always constitutes a grave, life-threatening condition. A case of ASM that developed from a retropharyngeal abscess in a previously healthy 10-year-old boy is reported. Repeated cervical and thoracic drainage, massive intravenous antibiotics, and continuous mediastinal irrigation resulted in gradual improvement and complete recovery within 3 weeks. Since a successful outcome depends on early recognition, suitable diagnostic imaging is mandatory. A CT scan proved to be the most accurate diagnostic tool. The anatomy, etiology, and bacteriology of these infections are briefly reviewed. As dramatically illustrated by this case, the appropriate surgical treatment is controversial; the rationale for different approaches is discussed.