Descending necrotizing mediastinitis after a trigger point injection.
- Author:
Jae Young CHOE
1
;
Jong Kun KIM
;
Dong Eun LEE
;
Kang Suk SEO
;
Jung Bae PARK
;
Mi Jin LEE
;
Hyun Wook RYOO
;
Jae Yun AHN
;
Sungbae MOON
Author Information
- Publication Type:Case Report
- Keywords: Mediastinitis; Injections; Intramuscular; Tomography, X-ray computed
- MeSH: Aged; Anti-Bacterial Agents; Death, Sudden; Early Diagnosis; Emergency Service, Hospital; Fever; Humans; Mediastinitis*; Prognosis; Rupture; Shock, Septic; Superficial Back Muscles; Thorax; Tomography, X-Ray Computed; Trigger Points*
- From: Clinical and Experimental Emergency Medicine 2017;4(3):182-185
- CountryRepublic of Korea
- Language:English
- Abstract: Descending necrotizing mediastinitis (DNM) is a rare form of mediastinal infection. Most cases are associated with esophageal rupture. DNM after a trigger point injection in the upper trapezius has not been described previously. We present a case of DNM after a trigger point injection in the upper trapezius. A 70-year-old man visited the emergency department with chest discomfort and fever after a trigger point injection in the left upper trapezius. Chest computed tomography showed evidence of DNM, and antibiotic therapy was immediately administered intravenously. Because of the risk of sudden death, poor prognosis due to underlying disease, and his age, he declined surgical treatment and died of septic shock. Although trigger point injections are generally considered safe, caution should be used in patients with an underlying disease or in the elderly. Early diagnosis, broad-spectrum antibiotics, and aggressive surgical management are essential to improve the prognosis.
