Medical Science - Case Report A case of mediastinitis secondary to retropharyngeal abscess Aparajeet Kar, S. Dharmic, V. Suryanarayana, M. Harish
Department of Pulmonary Medicine, Sree Balaji Medical College and Hospital, Bharath University, Chennai, Tamil Nadu, India Address for correspondence: Dr. S. Dharmic, E‑mail: micdamy@ yahoo.com Received : 31-10-14 Review completed : 31-10-14 Accepted : 09-11-14
ABSTRACT A 50 year old male patient who consumed chicken bone soup, 4 days back, presented with dysphagia, high grade fever with chills, shortness of breath and swelling in face, neck and upper chest. Patient was toxic and in respiratory distress with room air oxygen saturation of 83%, which increased to 92% with 6 lit of oxygen through simple face mask. Indirect laryngoscopy revealed a retro pharyngeal abscess and CT chest revealed Sub-cutaneous and mediastinal emphysema. The abscess was immediately drained and followed with parenteral anti-microbials and high flow oxygen theapy. Patient improved and was discharged after 12 days. This case was reported as, foreign body causing Retro-pharyngeal abscess is a very rare entity in this anti-biotic era especially leading to a very rare complication of mediastinitis and Pneumomediastinum is unusual.
KEY WORDS: Chicken bone, mediastinitis, Pneumomediastinum, retro-pharyngeal abscess
R
etropharyngeal abscesses are rare in adults. They occur mostly in immunocompromised patients or as a complication of foreign body impaction. In adults, retropharyngeal abscesses can occur as a result of local trauma, such as foreign body ingestion (fishbone), or instrumental procedures (laryngoscopy, endotracheal intubation, feeding tube placement, etc.), or in the particular context of an associated disease.[1,2] Here, we present a case of mediastinitis after rupture of retropharyngeal abscess, which occurred after chicken bone injury.
Clinical examination revealed subcutaneous emphysema in face, neck and upper chest and severe stridor. Patient was febrile, toxic and in respiratory distress with room air oxygen saturation of 83%, which increased to 92% with 6 l of oxygen through simple face mask. Indirect laryngoscopy revealed a retro pharyngeal abscess [Figure 1].
Treatment
Case Report A 50‑year‑old male patient presented with a history of consuming chicken bone soup, 4 days back. Since then, he had difficulty and pain during swallowing. 2 days later he developed high grade fever with chills, shortness of breath and swelling in face, neck and upper chest. He had no chronic medical or surgical comorbid illnesses. Access this article online Quick Response Code:
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Hypotension was managed with fluid resuscitation, vasopressors. Due to impending airway compromise and respiratory arrest, abscess was drained immediately and the patient was put on antimicrobials. A post drainage computed tomography neck and chest revealed a subcutaneous emphysema and mediastinal emphysema. Patient was put on continuous high flow oxygen and supportive care was given.
Outcome and Follow‑up
www.jpbsonline.org
Patient steadily improved and was discharged after 12 days.
DOI:
Discussion
10.4103/0975-7406.155805
Mediastinitis secondary to spread of infection from elsewhere How to cite this article: Kar A, Dharmic S, Suryanarayana V, Harish M. A case of mediastinitis secondary to retropharyngeal abscess. J Pharm Bioall Sci 2015;7:S63-4.
Journal of Pharmacy and Bioallied Sciences April 2015 Vol 7 Supplement 1
S63
Kar, et al.: A rare cause of Pneumomediastinum
Figure 1: Computed tomography chest-mediastinal emphysema
has become rare in the antibiotic era.[3] The usual route of spread of oropharyngeal infections is via retropharyngeal space to mediastinum.[4‑6] The mainstay of treatment for mediastinitis is open drainage via a cervical or thoracic approach.[3,4] In this particular case, the patient improved with retropharyngeal abscess drainage and antimicrobials and supportive care.
3. 4. 5. 6.
References 1. 2.
Ngan JH, Fok PJ, Lai EC, Branicki FJ, Wong J. A prospective study on fish bone ingestion. Experience of 358 patients. Ann Surg 1990;211:459‑62. Arora S, Sharma JK, Pippal SK, Yadav A, Najmi M, Singhal D. Retropharyngeal abscess following a gun shot injury. Braz J
S64
Otorhinolaryngol 2009;75:909. Kiernan PD, Hernandez A, Byrne WD, Bloom R, Dicicco B, Hetrick V, et al. Descending cervical mediastinitis. Ann Thorac Surg 1998;65:1483‑8. Estrera AS, Landay MJ, Grisham JM, Sinn DP, Platt MR. Descending necrotizing mediastinitis. Surg Gynecol Obstet 1983;157:545‑52. Corsten MJ, Shamji FM, Odell PF, Frederico JA, Laframboise GG, Reid KR, et al. Optimal treatment of descending necrotising mediastinitis. Thorax 1997;52:702‑8. Freeman RK, Vallières E, Verrier ED, Karmy‑Jones R, Wood DE. Descending necrotizing mediastinitis: An analysis of the effects of serial surgical debridement on patient mortality. J Thorac Cardiovasc Surg 2000;119:260‑7.
Source of Support: Nil, Conflict of Interest: None declared.
Journal of Pharmacy and Bioallied Sciences April 2015 Vol 7 Supplement 1
Copyright of Journal of Pharmacy & Bioallied Sciences is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Department of Pulmonary Medicine, Sree Balaji Medical College and Hospital, Bharath University, Chennai, Tamil Nadu, India Address for correspondence: Dr. S. Dharmic, E‑mail: micdamy@ yahoo.com Received : 31-10-14 Review completed : 31-10-14 Accepted : 09-11-14
ABSTRACT A 50 year old male patient who consumed chicken bone soup, 4 days back, presented with dysphagia, high grade fever with chills, shortness of breath and swelling in face, neck and upper chest. Patient was toxic and in respiratory distress with room air oxygen saturation of 83%, which increased to 92% with 6 lit of oxygen through simple face mask. Indirect laryngoscopy revealed a retro pharyngeal abscess and CT chest revealed Sub-cutaneous and mediastinal emphysema. The abscess was immediately drained and followed with parenteral anti-microbials and high flow oxygen theapy. Patient improved and was discharged after 12 days. This case was reported as, foreign body causing Retro-pharyngeal abscess is a very rare entity in this anti-biotic era especially leading to a very rare complication of mediastinitis and Pneumomediastinum is unusual.
KEY WORDS: Chicken bone, mediastinitis, Pneumomediastinum, retro-pharyngeal abscess
R
etropharyngeal abscesses are rare in adults. They occur mostly in immunocompromised patients or as a complication of foreign body impaction. In adults, retropharyngeal abscesses can occur as a result of local trauma, such as foreign body ingestion (fishbone), or instrumental procedures (laryngoscopy, endotracheal intubation, feeding tube placement, etc.), or in the particular context of an associated disease.[1,2] Here, we present a case of mediastinitis after rupture of retropharyngeal abscess, which occurred after chicken bone injury.
Clinical examination revealed subcutaneous emphysema in face, neck and upper chest and severe stridor. Patient was febrile, toxic and in respiratory distress with room air oxygen saturation of 83%, which increased to 92% with 6 l of oxygen through simple face mask. Indirect laryngoscopy revealed a retro pharyngeal abscess [Figure 1].
Treatment
Case Report A 50‑year‑old male patient presented with a history of consuming chicken bone soup, 4 days back. Since then, he had difficulty and pain during swallowing. 2 days later he developed high grade fever with chills, shortness of breath and swelling in face, neck and upper chest. He had no chronic medical or surgical comorbid illnesses. Access this article online Quick Response Code:
Website:
Hypotension was managed with fluid resuscitation, vasopressors. Due to impending airway compromise and respiratory arrest, abscess was drained immediately and the patient was put on antimicrobials. A post drainage computed tomography neck and chest revealed a subcutaneous emphysema and mediastinal emphysema. Patient was put on continuous high flow oxygen and supportive care was given.
Outcome and Follow‑up
www.jpbsonline.org
Patient steadily improved and was discharged after 12 days.
DOI:
Discussion
10.4103/0975-7406.155805
Mediastinitis secondary to spread of infection from elsewhere How to cite this article: Kar A, Dharmic S, Suryanarayana V, Harish M. A case of mediastinitis secondary to retropharyngeal abscess. J Pharm Bioall Sci 2015;7:S63-4.
Journal of Pharmacy and Bioallied Sciences April 2015 Vol 7 Supplement 1
S63
Kar, et al.: A rare cause of Pneumomediastinum
Figure 1: Computed tomography chest-mediastinal emphysema
has become rare in the antibiotic era.[3] The usual route of spread of oropharyngeal infections is via retropharyngeal space to mediastinum.[4‑6] The mainstay of treatment for mediastinitis is open drainage via a cervical or thoracic approach.[3,4] In this particular case, the patient improved with retropharyngeal abscess drainage and antimicrobials and supportive care.
3. 4. 5. 6.
References 1. 2.
Ngan JH, Fok PJ, Lai EC, Branicki FJ, Wong J. A prospective study on fish bone ingestion. Experience of 358 patients. Ann Surg 1990;211:459‑62. Arora S, Sharma JK, Pippal SK, Yadav A, Najmi M, Singhal D. Retropharyngeal abscess following a gun shot injury. Braz J
S64
Otorhinolaryngol 2009;75:909. Kiernan PD, Hernandez A, Byrne WD, Bloom R, Dicicco B, Hetrick V, et al. Descending cervical mediastinitis. Ann Thorac Surg 1998;65:1483‑8. Estrera AS, Landay MJ, Grisham JM, Sinn DP, Platt MR. Descending necrotizing mediastinitis. Surg Gynecol Obstet 1983;157:545‑52. Corsten MJ, Shamji FM, Odell PF, Frederico JA, Laframboise GG, Reid KR, et al. Optimal treatment of descending necrotising mediastinitis. Thorax 1997;52:702‑8. Freeman RK, Vallières E, Verrier ED, Karmy‑Jones R, Wood DE. Descending necrotizing mediastinitis: An analysis of the effects of serial surgical debridement on patient mortality. J Thorac Cardiovasc Surg 2000;119:260‑7.
Source of Support: Nil, Conflict of Interest: None declared.
Journal of Pharmacy and Bioallied Sciences April 2015 Vol 7 Supplement 1
Copyright of Journal of Pharmacy & Bioallied Sciences is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
