종격동염을 유발한 심경부감염 14예에 대한 임상적 고찰

이준규 대한이비인후과학회 2005 대한이비인후과학회지 두경부외과학 Vol.48 No.5

Background and Objectives:Acute mediastinitis occasionally occurs as a complication of deep neck infections, which spreads to the mediastinum via cervical fascial planes. The purpose of this article is to investigate the differences in the clinical manifestation of deep neck infections between mediastinitis patients and non-mediastinitis patients so as to aid in the treatment of acute mediastinitis. Subjects and Method:The present study reviewed the medical records of 158 patients with deep neck infections from 1995 to 2004 and the author analyzed clinical findings of 14 patients with mediastinitis. To find out the characteristics of mediastintis patients, the author compared these patients with non-mediastinitis patients using student t-test and chisquare test. Results:Compared with the non-mediastinitis patients, the unique features of deep neck infections in mediastinitis patients were as follows:1) older age, 2) dyspnea on hospitalization, 3) tendency to involve multiple spaces, and 4) prolonged hospitalization (p<0.05). Transcervical drainage was performed in 11 cases and thoracotomy drainage in 3 cases. Three patients died of septic shocks after transcervical mediastinal drainage. Conclusion:In this study, patients with mediastinitis were found to have older age, dyspnea, multiple involved spaces, and longer hospitalization. Mediastinitis remain potentially fatal, but morbidity and mortality can be reduced when a combination of following factors is applied: early radiologic diagnosis, maintenance of airway, aggressive drainage of pus, and appropriate intravenous antibiotics.

Immediate Debridement and Reconstruction with a Pectoralis Major Muscle Flap for Poststernotomy Mediastinitis

Jang, Yu-Jin,Park, Myong-Chul,Park, Dong-Ha,Lim, Hyo-Seob,Kim, Joo-Hyoung,Lee, Il-Jae Korean Society of Plastic and Reconstructive Surge 2012 Archives of Plastic Surgery Vol.39 No.1

Background : Poststernotomy mediastinitis is a rare, but life-threatening complication, thus early diagnosis and proper management is essential for poststernotomy mediastinitis. The main treatment for mediastinitis is aggressive debridement. Several options exist for reconstruction of defects after debridement. The efficacy of immediate debridement and reconstruction with a pectoralis major muscle flap designed for the defect immediately after the diagnosis of poststernotomy mediastinitis is demonstrated. Methods : Between September 2009 and June 2011, 6 patients were referred to the Department of Plastic and Reconstructive Surgery and the Department of Thoracic and Cardiovascular Surgery of Ajou University Hospital for poststernotomy mediastinitis. All of the patients underwent extensive debridement and reconstruction with pectoralis major muscle flaps, advanced based on the pedicle of the thoracoacromial artery as soon as possible following diagnosis. A retrospective review of the 6 cases was performed to evaluate infection control, postoperative morbidity, and mortality. Results : All patients had complete wound closures and reduced severity of infections based on the erythrocyte sedimentation rate and C-reactive protein levels and a reduction in poststernal fluid collection on computed tomography an average of 6 days postoperatively. A lack of growth of organisms in the wound culture was demonstrated after 3 weeks. There were no major wound morbidities, such as hematomas, but one minor complication required a skin graft caused by skin flap necrosis. No patient expired after definitive surgery. Conclusions : Immediate debridement and reconstruction using a pectoralis major muscle flap is a safe technique for managing infections associated with poststernotomy mediastinitis, and is associated with minimal morbidity and mortality.

Immediate Debridement and Reconstruction with a Pectoralis Major Muscle Flap for Poststernotomy Mediastinitis

장유진,Il Jae Lee,박명철,박동하,임효섭,김주형 대한성형외과학회 2012 Archives of Plastic Surgery Vol.39 No.1

Background Poststernotomy mediastinitis is a rare, but life-threatening complication,thus early diagnosis and proper management is essential for poststernotomy mediastinitis. The main treatment for mediastinitis is aggressive debridement. Several options exist for reconstruction of defects after debridement. The efficacy of immediate debridement and reconstruction with a pectoralis major muscle flap designed for the defect immediately after the diagnosis of poststernotomy mediastinitis is demonstrated. Methods Between September 2009 and June 2011, 6 patients were referred to the Department of Plastic and Reconstructive Surgery and the Department of Thoracic and Cardiovascular Surgery of Ajou University Hospital for poststernotomy mediastinitis. All of the patients underwent extensive debridement and reconstruction with pectoralis major muscle flaps,advanced based on the pedicle of the thoracoacromial artery as soon as possible following diagnosis. A retrospective review of the 6 cases was performed to evaluate infection control,postoperative morbidity, and mortality. Results All patients had complete wound closures and reduced severity of infections based on the erythrocyte sedimentation rate and C-reactive protein levels and a reduction in poststernal fluid collection on computed tomography an average of 6 days postoperatively. A lack of growth of organisms in the wound culture was demonstrated after 3 weeks. There were no major wound morbidities, such as hematomas, but one minor complication required a skin graft caused by skin flap necrosis. No patient expired after definitive surgery. Conclusions Immediate debridement and reconstruction using a pectoralis major muscle flap is a safe technique for managing infections associated with poststernotomy mediastinitis,and is associated with minimal morbidity and mortality.

A Case of Postcardiac Injury Syndrome Presenting as Acute Mediastinitis

임홍규,배영필,이병두,김봉건,박종화,김분형,장재식 대한심장학회 2009 Korean Circulation Journal Vol.39 No.7

A 41-year-old man sought evaluation at the emergency department for pain in the anterior chest that had been ongoing for approximately 35 hours. The electrocardiogram showed marked ST segment elevation in the precordial leads. Cardiac biomarker levels were elevated. He subsequently underwent coronary angioplasty and stenting of the left anterior descending artery using two sirolimus-eluting stents. The following day, the patient complained of severe pain in his chest and shoulders. Computed tomography (CT) of the chest showed small gas bubbles around the aortic wall and mild pericardial thickening with subtle air densities, suggesting acute mediastinitis. With an impression of postcardiac injury syndrome and acute mediastinitis, he was treated with intravenous antibiotics and oral ibuprofen. Two days later, the patient had subjective improvement and the friction rub was no longer heard. A 41-year-old man sought evaluation at the emergency department for pain in the anterior chest that had been ongoing for approximately 35 hours. The electrocardiogram showed marked ST segment elevation in the precordial leads. Cardiac biomarker levels were elevated. He subsequently underwent coronary angioplasty and stenting of the left anterior descending artery using two sirolimus-eluting stents. The following day, the patient complained of severe pain in his chest and shoulders. Computed tomography (CT) of the chest showed small gas bubbles around the aortic wall and mild pericardial thickening with subtle air densities, suggesting acute mediastinitis. With an impression of postcardiac injury syndrome and acute mediastinitis, he was treated with intravenous antibiotics and oral ibuprofen. Two days later, the patient had subjective improvement and the friction rub was no longer heard.

종격동염의 증례보고

김재환(Jae Hwan Kim),류동목(Dong-Mok Ryu),지유진(Yu-Jin Jee),이정우(Jung-Woo Lee),이덕원(Deok-Won Lee) 대한구강악안면외과학회 2010 대한구강악안면외과학회지 Vol.36 No.6

Acute mediastinitis is a fatal infection which occurs related to connective tissue of mediastium, in the thoratic organs. Occurrence of mediastinitis due to craniocervical infection is very rare, and is defined as descending necrotizing mediastinitis. November 8th, 2008, man in his early fifties visited ER due to severe swelling on left neck area and dyspnea. Antibiotic were administered immediately, and vast amount of abscess formation on pneumomediastinum and adjacent tissues were observed via chest computed tomography. With cooperation of thoracic and cardiovascular surgery department, emergency incision and drainage with drain insertion was done to remove abscess, and control the infection. After surgery, everyday saline irrigation through drain was done during hospitalization, with continues antibiotic therapy. Descending necrotising mediastinitis is a most rare and dangerous infection which occurs on oropharyngeal area. In case of descending necrotising mediastinitis, accurate diagnosis, airway maintenance, remove of abscess by incision and drainage, aggressive antibiotic therapy and continuous saline irrigation is necessary to increase patient survivability. Also, computed tomography with contrast media is essential to figure out the size and location of the infection and abscess formation.

하행 괴사성 종격동염의 치험례

이인수,최환준,이한정,이재욱,이동기 대한성형외과학회 2009 Archives of Plastic Surgery Vol.36 No.3

Purpose: Cervical necrotizing fasciitis tends to involve the deep soft tissues and spread caudally to the anterior chest and mediastinum, often resulting in major complications and death. It may rapidly spread into the thorax along fascial planes, and the associated diagnostic delay results in this descending necrotizing mediastinitis. So, aggressive multidisciplinary therapy with surgical drainage is mandatory. We present a very rare case of descending necrotizing mediastinitis with literature review. Methods: A 53 years old male visited our department 7 days after trauma in neck. His premorbid conditions and risk factors of necrotizing fasciitis were concealed hepatoma, trauma history, chronic liver disease, and nutrition deficit. Computed tomographic scans of the head and neck region were performed in this patient: signs of necrotizing fasciitis, were seen in the platysma, sternocleidomastoid, trapezius muscle and strap muscles of the neck. Fluid accumulations involved multiple neck spaces and mediastinum. At the time, he diagnosed as necrotizing fasciitis on his neck and anterior chest. Necrotic wound was excised serially and we treated this with the Vacuum-assisted closure(VAC, Kinetics Concepts International, San Antonio, Texas) system device. After appropriately shaping the sponge and achieving additional 3 pieces drainage tubes in the pockets, continuous negative pressure of 125mmHg was applied. The VAC therapy was applied for a period of 12 days. Results: We obtained satisfactory results from wide excision, abscess drainage with the VAC system, and then split thickness skin graft. The postoperative course was uneventful. Conclusion: The refined technique using the VAC system can provide a means of simple and effective management for the descending necrotizing mediastinitis, with better cosmetic and functional results. Finally, the VAC system has been adopted as the standard treatment for deep cervical and mediastinal wound infections as a result of the excellent clinical outcome.

Localized Fibrosing Mediastinitis Causing Pulmonary Infarction: A Case Report

서영균,김은영,강두경,박경주,고영화,선주성 대한영상의학회 2016 대한영상의학회지 Vol.74 No.6

A 44-year-old female patient visited our emergency room for hemoptysis and refractory chest wall pain of 2 months duration. She had no history of smoking or other medical conditions. Chest CT scan showed homogenously enhancing soft tissue mass without calcification at the left pulmonary hilum. Encasing and compression of the left lower pulmonary artery by the mass had resulted in pulmonary infarction in the left lower lobe. Laboratory tests for tuberculosis, fungus, and vasculitis were all negative. The patient underwent surgical biopsy and resection of infarcted left lower lobe that was histopathologically confirmed as fibrosing mediastinitis. Herein, we reported a rare case of surgically confirmed and treated localized fibrosing mediastinitis causing pulmonary infarction.

흉골 절개술 후 발생한 흉골 감염 및 종격동염의 Vacuum-assisted closure를 이용한 치료 - 3례 보고 -

장원호,허균,박영우,김현조,정윤섭,염욱 대한흉부외과학회 2002 Journal of Chest Surgery (J Chest Surg) Vol.35 No.2

=Vacuum-Assisted Closure in Treatment of Poststernotomy Wound Infection and Mediastinitis- Three cases report - 흉골 절개술 후 종격동염은 드물게 발생하나 심장 수술 후 생명을 위협하는 합병증으로 발전 할 수 있다. 지금까지는 흉골 절개술 후 발생한 창상 감염의 치료로서 창상 세척과 변연 절제술 후 직접 상처 부위를 봉합하거나 근육 피판을 사용하여 왔다. 흉골 절개술 후 발생한 창상 감염의 새로운 치료로서 VAC (Vacuum-assisted closure) 술기에 대해 기술 하고자 한다. 이 술기를 흉골 절개술 후 발생한 창상감염 및 종격동염 환자 3명에게 성공적으로 적용하였고, 이러한 새로운 방식으로 흉골 부위 상처를 치유할 수 있었다.

개심술 후 발생한 급성 종격동염과 흉골골수염 : 대망편을 이용한 치료

최강주 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.3

흉골절개술 후 발생한 종격동염은 치명적인 합병증으로 알려져 있다. 종격동에 대망편을 전위하는 방법은 이러한 심각한 합병증을 치료하는 몇 가지 방법 중 하나이다. 흉골절개로 승모판막치환술은 받은 57세 여자환자에게서 발생한 종격동염을 치료하기 위해 대망편 전위술을 시행하였다. 골수염을 가진 흉골을 전부 제거한 후 대망편을 전위시켰다. 수술 후 환자는 특별한 합병증 없이 퇴 원하였다. Post-sternotomy mediastinitis has been known as a lethal complication. Omental flap transposition is one of the few procedures to treat this severe complication. A 57-year-old female patient who underwent mitral valve replacement using median sternotomy was performed omental flap transposition to treat post-sternotomy mediastinitis. The greater omentum was used to fill the space after resection of the infected sternum. After uneventful operation, the patient was discharged with no complications.

이스트에 의한 하행 괴사성 종격동염 -치험 1예-

윤영철,조광현,김성룡,전희재,최강주,이양행,황윤호 대한흉부외과학회 2004 Journal of Chest Surgery (J Chest Surg) Vol.37 No.4

Descending nectorizing mediastinitis (DNM) represents a virulent form of mediastinal infection requiring prompt diagnosis and treatment to reduce the high morbidity mortality associated with this disease. Intr.avenous broad-spectrum antibiotic therapy alone is not efficient without adequate surgical drainage of the cervical and mediastinal collections, extensive debridement and excision of necrotic tissue, and wide mediastino-pleural irrigation. A 38-year-old man admitted via emergency room with painful left neck swelling and uncontrolled high fever. Chest computed tomogram showed left paratracheal abscess descending into the superior and anterior mediastinum. Transcervical mediastinal drainage was performed with 26 Fr. chest tube and left paratracheal drainage was performed with Penrose drain in urgency. Culture and sensitivity test grew Yeast. The drains removed via gradually shortening on day 39 after surgery. 하행 괴사성 종격동염은 이완율과 사망률을 감소시키기 위하여 조기 진단과 적극적인 치료를 요한다. 적절한 외과적 배농술, 광범위한 괴사조직의 변연 절제와 절제술, 혹은 종격동-흉강 세척술 없이 정주 항생제 사용만으로는 효과적이지 못하다. 좌측 경부의 동통이 동반된 부종과 지속적인 고열을 주소로 38세 남자가 응급실을 내원하였다. 컴퓨터단층촬영상 좌측 기관지 주변, 상 종격동, 전 종격동의 농양 소견을 보여 응급으로 횡경부 종격동 절개를 통하여 26 Fr. 흉관을 이용한 종격동 배농술과 펜로즈 배농관을 이용한 우측 기관지 주변부 배농술을 실시하였다. 균 배양 검사 결과 이스트가 동정되었다. 배농관은 점차 절단하면서 술 후 39일째에 제거할 수 있었다.