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J Thorac Cardiovasc Surg 2007;133:271-272
© 2007 The American Association for Thoracic Surgery

Brief Communication

Descending necrotizing mediastinitis in a child with chickenpox

^a Pediatric Critical Care Unit, San Rafael Children’s Hospital, Madrid, Spain
^b Department of Pediatric Surgery, San Rafael Children’s Hospital, Madrid, Spain.

Received for publication July 20, 2006; accepted for publication September 5, 2006.

^_* Address for reprints: Alfonso Pérez Palomino, MD, Pediatric Critical Care Unit, San Rafael Children’s Hospital, Madrid, Spain. (Email: gonsigonsi@yahoo.es).

The first 20% of the full text of this article appears below.

One of the most dreaded forms of mediastinitis is descending necrotizing mediastinitis (DNM), with a reported mortality of 40% to 50%.¹ It occurs as a complication of infections that arise from odontogenic (50%–60%) or cervicofascial infections or cervical trauma and can complicate various clinicopathologic conditions. Although the diagnostic characteristics and need for antibiotics are accepted, the type of drainage is controversial. Surgical management, and particularly the optimal form of mediastinal drainage, remains controversial, with support ranging from cervical drainage alone to cervical drainage and routine thoracotomy. We present a clinical case of DNM in a child with chickenpox.

Clinical Summary

A 4-year-old-boy was admitted to our hospital with severe respiratory distress, cyanosis, fever, tachycardia, hypotension, cutaneous rash on the chest and abdomen, and several residual skin blisters. Five days earlier he had received a diagnosis of chickenpox. Bilateral alveolar infiltrates, enlarged mediastinum, and bilateral pleural effusion were assessed by chest radiography. Empirical treatment . . . [Full Text of this Article]