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Pyomyositis is an acute bacterial infection of the skeletal muscle that is commonly associated with localized abscess formation. It is estimated that pyomyositis accounts for up to 4% of all hospital admissions throughout Asia, tropical Africa, Oceania and the Caribbean Islands. However, there has been an increasing emergence of pyomyositis in temperate climates and high-income countries. Staphylococcus aureus is the most common organism implicated. Management requires a high index of clinical suspicion, prompt diagnosis and early management to prevent sequalae that can be fatal if left untreated. We describe an interesting case of pyomyositis in an otherwise fit and immunocompetent individual causing mediastinitis; a rare sequalae of the disease. Percutaneous drainage of his left pectoral abscess and a prolonged course of antibiotics provided complete clinical and radiological resolution of the disease despite mediastinal extension. Here we discuss aetiology, associations, pathophysiology and epidemiology of pyomyositis with associated sequalae of the disease. [ABSTRACT FROM AUTHOR]

We report the case of a healthy 35-year-old male with two rare pathologies: pneumopericardium and oesophago-pericardial fistula (OPF) secondary to tuberculosis. Purulent pericarditis and cardiac tamponade are known complications with potential for significant morbidity and mortality. Unfortunately, the symptoms of OPF are non-specific often delaying diagnosis. There is no gold standard for treatment or determinant of when nonsurgical versus surgical approach should be considered. Anti-tuberculous therapy alone is often adequate however an oesophageal stent was utilized in this case to rapidly gain control of the fistula and prevent ongoing contamination from mediastinitis. [ABSTRACT FROM AUTHOR]

Descending necrotizing mediastinitis (DNM) is a severe, life-threatening disease and requires prompt treatment. The primary treatment for DNM is cervical and mediastinal drainage in addition to antibiotic treatment. However, the most appropriate drainage approach and the effectiveness of additional treatment remain unclear. In this study, we performed cervical and mediastinal drainage for three patients with type IIB DNM using the cervical approach alone. Continuous saline irrigation was administered as additional treatment. There is little evidence for the use of saline irrigation for DNM. We propose that this combination treatment may be more effective and has the potential to improve patient prognosis. In our report, the average drainage duration was 13 days, and the average hospital stay was 30 days. Furthermore, both drainage duration and hospital stay were shorter than those in previously reported cases. Our case series provides valuable insight into the use of combination treatment to treat DNM. [ABSTRACT FROM AUTHOR]

We report about a 61-year-old man who, 6 years after initial uncomplicated mitral valve repair and 3 months after treatment of a pseudo-aneurysm of the ascending aorta with a Dacron patch, was admitted in our institution with an infection of the vascular graft, which was associated with sternal osteomyelitis and purulent cutaneous fistula. In a re-redo procedure, the proximal aortic arch and the ascending aorta were replaced with a cryopreserved aortic homograft. The infected part of the sternum was resected and the defect was covered by mobilizing the mediastinal tissue and with a bilateral muscle flap. The patient was discharged 20 days after surgery. This treatment concept outlines the benefit of cryopreserved aortic homograft when faced with a complex thoracic aortic infection. [ABSTRACT FROM AUTHOR]

Pneumomediastinum is the presence of mediastinal air, which raises concern for life-threatening conditions such as esophageal perforation and mediastinitis. Here, we described the case of a young female with no previous past medical history, who developed spontaneous pneumomediastinum following uncomplicated spontaneous vaginal delivery (SVD) giving birth to a healthy newborn at full term. The incidence of benign pneumomediastinum following SVD is estimated at 1 in 100 000 deliveries. This case explores the etiology of this rare presentation, recommends essential investigations and advises on pertinent clinical considerations. [ABSTRACT FROM AUTHOR]

Background: This report presents an immunocompetent lady suffering from Candida parapsilosis associated with polybacterial cervical necrotizing fasciitis and descending mediastinitis. A literature review and management of invasive candidiasis is discussed. Methods: A 57-year-old healthy lady presented with cervical necrotizing fasciitis and descendingmediastinitis. She was promptly managed with emergency debridement. Both blood and tissue culture yielded multiple microorganisms including C. parapsilosis. Results: The patient recovered progressively. She was discharged 2 months later. Conclusions: Fungal infection is emerging in this medical era. Vigilance in patient management and as well as considering atypical microorganisms in aetiology may improve patient outcome. [ABSTRACT FROM AUTHOR]

Pneumomediastinum (PM) is mainly an atypical finding among traumatic neck or thoracic injury patients. Moreover, PM secondary to isolated orbital floor fracture remains a rare event which is infrequently associated with severe complications such as mediastinitis, airway obstruction and pneumothorax. Herein, we report an atypical case of mediastinal emphysema consequent to orbital floor fracture along with review of the literature. [ABSTRACT FROM AUTHOR]

Boerhaave syndrome is a spontaneous perforation of the oesophagus secondary to forceful emesis. Surgery has been advocated in delayed presentations of Boerhaave's syndrome with mediastinitis. The over-the-scope clip (OTSC) by OVESCOw (Tubingen, Germany) has been used in the endoscopic management of gastrointestinal bleeds, fistulae and anastamotic leaks. We describe the successful endoscopic use of the OTSC in a delayed presentation of Boerhaave syndrome with mediastinitis. A 69-year-old gentleman underwent a computerised tomography scan, which demonstrated a lower oesophageal perforation and mediastinitis 7 days after admission, having presented with forceful emesis and chest discomfort. During endoscopy the defect was visualized and successfully closed using the OTSC. This resulted in a favourable outcome and is a technique not previously described in the literature to manage this condition. [ABSTRACT FROM AUTHOR]

Descending mediastinitis is a rare, life-threatening condition caused by contiguous spread of oropharyngeal or cervical infection into the mediastinum. Infectious mononucleosis generally results in a self-limited illness characterized by fever, pharyngitis and lymphadenopathy. We present an exceptional case of an 18-year-old with infectious mononucleosis complicated by progressive bacterial superinfection and fulminant descending mediastinitis. After resuscitation, broad spectrum antibiotics, critical care support and definitive surgical management, they made a full recovery. [ABSTRACT FROM AUTHOR]