Subacute Descending Necrotizing Mediastinitis

Descending necrotizing mediastinitis (DNM) is a rare disease and mainly related to the spread of oropharyngeal and odon­togenic infections into the mediastinum. DNM is a life-threat­ening disease with a reported mortality of 40-50%. The main­stays of treatment of DNM are surgical drainage and appro­priate antibiotic therapy. However, there are a lot of specu­lations concerning the ideal form of surgical approach in the patients with DNM. We report a case of DNM secondary to Ludwig’s angina with fistula to the left pleural cavity. The drainage of the mediastinum was achieved by the computed tomography guided catheter. The left pleural cavity was also drained by percutaneous catheter. A thorax computed tomography obtained one year after the treatment revealed no sequela. We think that, if the patient is in good condition, even complicated DNM can be treated without aggressive surgery.