[Descending necrotizing mediastinitis].

Descending necrotizing mediastinitis (DNM) is a life-threatening condition, in which infection arising from deep neck tissue spreads downwards into the mediastinum. Contrast-enhanced cervico-thoracic computed tomography (CT) scan is vital for appreciate of the extent and location of mediastinal involvement. Treatment of DNM begins with intravenous administration of a broad-spectrum antibiotic covering both aerobes and anaerobes. Immediate transcervical drainage and debridement with or without transthoracic mediastinal drainage should be considered. Transthoracic mediastinal drainage has to be performed when the mediastinal infection has spread below the carina and/or the Th4 vertebra. Moreover, it is important to determine whether additional drainage is required by evaluation using regular CT imaging. The overall reported mortality rate since 1960 has been 31%, but from 1999 to 2008 it has been 15.5%.