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  • Taking heed of the ‘danger space’: acute descending necrotising mediastinitis secondary to primary odontogenic infection

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Reminder of important clinical lesson
CASE REPORT
Taking heed of the ‘danger space’: acute descending necrotising mediastinitis secondary to primary odontogenic infection
  1. Rose Mark1,
  2. Swithin Song1,
  3. Peter Mark2
  1. 1Radiology, Royal Perth Hospital, Perth, Western Australia, Australia
  2. 2Radiology, Fiona Stanley Hospital, Murdoch, Australia
  1. Correspondence to Dr Rose Mark, rose.mark{at}health.wa.gov.au

Summary

Descending necrotising mediastinitis (DNM) is an uncommon clinical entity which may arise secondary to primary odontogenic or neck infection in susceptible patients. Infection may spread contiguously via the alar or ’danger' space, a potential anatomical space posterior to the true retropharyngeal space.1 Spread of infection to the mediastinum almost always necessitates urgent cardiothoracic surgical intervention.2–4 This case report describes a male patient whose clinical deterioration following the diagnosis of submandibular abscess was investigated with CT imaging of the chest, where a diagnosis of DNM was made. Diagnosis was confirmed following surgical intervention and aspiration of pus from the mediastinum.

  • radiology
  • mouth
  • cardiothoracic surgery
  • dentistry and oral medicine

https://doi.org/10.1136/bcr-2018-225019

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    Footnotes

    • Contributors RM: reported radiology case in after hours context. Review of literature, planning and write-up of case, search for morbidity and mortality data. Co-ordination of resubmission of paper. SS: reviewed case, provided feedback regarding causative mechanisms for infection, liaison with treating team. PM: liaison with treating surgical team, liaison with patient, follow-up of patient, editing final case report. Also extended follow-up with patient postdischarge.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None required.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.