alexa Mediastinitis in infants from deep neck space infections.


Emergency Medicine: Open Access

Author(s): Shah RK, Chun R, Choi SS

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Abstract 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. This article was published in Otolaryngol Head Neck Surg and referenced in Emergency Medicine: Open Access

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