A CASE OF DESCENDING NECROTISING MEDIASTINITIS WITH MEDIASTINO-PERICARDIOPLEURAL FISTULA

Descending necrotising mediastinitis is a rare but serious complication following oropharyngeal infections with high mortality.The infection spreads to the mediastinum through the cervical fascial planes.Although desceding necrotising mediastinitis is a serious complication following oropharyngeal infection,abscess and fistula formation involving pericardium and pleura is rarely seen in this antibiotic era.Mortality rate is high (30-40 percentage)and it might require aggressive surgical drainage,along with broad spectrum antibiotics.We report a case of descending necrotising mediastinitis complicated by mediastino-pericardio -pleural fistula in a 44 year old male,who presented with dyspnea,right sided pleuritic chest pain and fever of 2 weeks duration with history of painful swelling in the submandibular region which got reduced after surgical drainage 2 months before,diagnosed as descending necrotising mediastinitis with mediastino-pericardio-pleural fistula who improved with surgical drainage and broad spectrum antimicrobials.