Causes, pathways and diagnostic errors in patients with descending purulent mediastinitis

Background. The high incidence of purulent mediastinitis induces surgeons to find the causes of the development and ways of purulent content spreading from the neck to the mediastinum. Purpose was to determine the most common causes of neck phlegmon, to study the ways of infection spreading into the mediastinal fat, to determine the typology of diagnostic errors and to conduct a mortality analysis, depending on the cause of the disease and the form of acute mediastinitis. Materials and methods. An analysis was performed of the data obtained from 65 patients with neck phlegmon and purulent mediastinitis treated at the thoracic department of the Ivano-Frankivsk Regional Clinical Hospital during 2000–2017. Results. The anterosuperior purulent mediastinitis was diagnosed in 22 (33.8 %), total — in 19 (29.2 %), upper — in 16 (24.6 %), and posterior — in 8 (12.3 %) patients. In 52 % of patients, purulent mediastinitis occurred in case of neck phlegmon localization in the retrovisceral space, in 40.8 % — in the previsceral space. The leading causes of purulent mediastinitis development were tonsilogenic and odontogenic factors, which were established in 80 % of patients. Postoperative lethality in purulent mediastinitis was 26.1 % (17 out of 65 patients died), total purulent mediastinitis was diagnosed in 12 (70.5 %), the upper — in 3 (17.6 %), the posterior — in 2 (11.7 %) of patients. Conclusions. Descending purulent mediastinitis occurred in 52 % of patients with neck phlegmon localization in the retrovisceral space, in 40.8 % of patients — with localization of neck phlegmons in the previsceral space. The leading causes of the descending purulent mediastinitis were odontogenic and tonsilogenic factors found in 71 % of patients. The mortality rate of descending total purulent mediastinitis was 70.5 %.