Acute necrotizing mediastinits: a series of four patients.

Background: Acute Necrotizing Mediastinitis (ANM) is a lethal disease that without antibiotic therapy and surgical Intervention has a mortality rate about 40% in best medical centers. With development of imaging technology (spiral CT- Scan) and shortening in time of diagnosis and surgery, the outcome and prognosis of the patients are improved. The surgical modalities are trans- cervical and trans- thoracic approaches. Case series: We present a series of four patients with acute necrotizing mediastinitis that admitted to thoracic surgery ward in vali-e-asr Hospital in Tehran, Iran, during years 2009 and 2010. A 31years old woman and three male patients with ages 21, 25 and 63 years. Odontogenic infection was the cause in two cases while pharyngeal perforation and cervical esophageal perforation were the causes of acute necrotizing mediastinitis the others. Results: Mean±SD of hospitalization time was 24±6 days. Infection of cervical space (periviceral spaces) and the superior mediastinum were found in all patients while extension of infection below the carina was found in two of them. All patients were operated by trans- cervical approach. One patient was operated by trans- thoracic approach. All patients were discharged with good general condition. Conclusion: Early usage of spiral CT- scan for diagnosis of acute necrotizing mediastinitis and early drainage with trans- cervical approach could be life saving in acute necrotizing mediastinitis patients with good results. [ABSTRACT FROM AUTHOR]