Mediastinitis in infants from deep neck space infections. Otolaryngol Head Neck Surg 2009 Jun;140(6):936-8
Date
05/27/2009Pubmed ID
19467419DOI
10.1016/j.otohns.2009.02.032Scopus ID
2-s2.0-65649109783 (requires institutional sign-in at Scopus site) 20 CitationsAbstract
OBJECTIVE: To describe mediastinitis in infants.
STUDY DESIGN: Case series.
SETTING: Tertiary-care, academic, pediatric hospital.
SUBJECTS: Four infants managed during eight months.
RESULTS: Patients were eight months (two patients), nine months, and 18 months old. They had retropharyngeal phlegmons and were started on clindamycin/cephalosporin. Interval imaging scans revealed abscess formation with mediastinal extension. All retropharyngeal abscesses were drained; three patients required video-assisted thoracoscopic debridement. Methicillin-resistant Staphylococcus aureus (two patients) and methicillin-sensitive Staphylococcus aureus (two patients) were cultured. Peak white blood cell counts were 15,000, 18,400, 30,200, and 44,900. The patients survived without long-term morbidity.
CONCLUSIONS: In infants with pediatric deep neck space infections, increased vigilance should be maintained for progression to mediastinal extension. Optimal management includes imaging of the neck and chest as indicated, broad-spectrum antibiotic coverage, and aggressive surgery as warranted to clear the neck space infections with appropriate surgical consultants to manage the mediastinal process. Despite high morbidity and mortality in adult mediastinitis, infant mediastinitis may be a different disease process as all patients survived without sequelae.
Author List
Shah RK, Chun R, Choi SSAuthor
Robert H. Chun MD Professor in the Otolaryngology department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AbscessAnti-Bacterial Agents
Drainage
Female
Humans
Infant
Male
Mediastinitis
Neck
Staphylococcal Infections
Staphylococcus aureus
Tomography, X-Ray Computed
