Perforation of the hypopharynx, which can occur after anterior cervical approach, is a very rare type of complication. If diagnosed late, it can lead to very fatal course, such as mediastinitis and hematosepsis. Therefore, a precise and prompt diagnosis is crucial. When conservative treatment alone is not expected to heal the perforated site or is likely to lead to serious complications, surgical treatment becomes necessary. This report demonstrates that surgical intervention performed immediately after an early diagnosis can lead to the successful treatment of a large perforation in the hypopharynx on a 58-year-old male patient.
Early Diagnosis ; Humans ; Hypopharynx ; Male ; Mediastinitis

Spontaneous pneumomediastinum is an uncommon disorder, and usually affects young men and has a benign course. Common triggers are asthma, the smoking of illicit drugs, the Valsalva maneuver, and respiratory infections. Most cases are usually due to alveolar rupture into the pulmonary interstitium caused by excess pressure. The air dissects to the hilum along the peribronchovascular sheaths and spreads into the mediastinum. However, pneumomediastinum following pharyngeal perforation is very rare, and has only been reported in relation to dental procedures, head and neck surgery, or trauma. We report a case of pneumomediastinum that developed in a 43-year-old patient with pharyngeal perforation after shouting. His course was complicated by mediastinitis and parapneumonic effusions.
Adult ; Humans ; Male ; Mediastinal Emphysema/*diagnosis ; Mediastinitis/*diagnosis ; Pharynx/*injuries

Intramural dissection of the esophagus is a rare esophageal disorder which reveals characteristic endoscopic and radiologic features. Some authors have recognized that this injury is an intermediate stage between a transmural esophageal rupture (Boerhaave's syndrome) and an esophageal mucosal tear (Mallory-Weiss syndrome). Presenting symptoms are sudden severe retrosternal pain, hematemesis, odynophagia, and dysphagia. The diagnosis is made by contrast esophagography, esophageal endoscopy, or both. Conservative management is usually successful. Surgery should be reserved for the cases of protracted disease or perforation with mediastinitis. We report a case of spontaneous intramural esophageal dissection, in which the symptom of dysphagia did not improve with a conservative management. Then we treated with an endoscopic incision of the septum between the true and false lumens using a needle type papillotome.
Deglutition Disorders ; Diagnosis ; Endoscopy ; Esophagus* ; Hematemesis ; Mediastinitis ; Needles ; Rupture

mediastinitis (DNM) is a complication of odontogenic or oropharyngeal infections that can spread to the mediastinum. Such infections is serious, leading to sepsis and frequently to death. Even in this era of antibiotics, the mortality rate associated with DNM is approximately 40%. It is difficult to diagnose early because clinical and radiologic findings appear in the late stage of the infection. Delayed diagnosis is the principal reason for the high mortality in DNM. Therefore, descending necrotizing mediastinitis requires an early and aggressive surgical approach to reduce the high morbidity and mortality associated with this disease. We experienced a case of odontogenic infection followed by acute mediastinitis , so present now with the review of literatures.]]>
Anti-Bacterial Agents ; Delayed Diagnosis ; Mediastinitis ; Mediastinum ; Sepsis

Foreign bodies of the parapharyngeal space are rarely encountered in the otolaryngological fields, and may cause severe complications such as descending suppurative mediastinitis, jugular thrombophlebitis with septic pulmonary emboli, cavernous sinus thrombosis, and carotid erosion. Therefore, early diagnosis and surgical intervention are needed to reduce morbidity and motality. Recently, we experienced two cases penetrating injury of parapharyngeal foreign bodies (woodstick). The one was penetrated in right parapharyngeal space from left medial canthal area and the other in left parapharyngeal space from left infraorbital area. They were removed by skin incision and transantral approach with Caldwell-Luc operation, and we report these cases with a review of literature.
Cavernous Sinus Thrombosis ; Early Diagnosis ; Foreign Bodies* ; Mediastinitis ; Skin ; Thrombophlebitis

Primary cardiac lymphoma is an uncommon malignancy, accounting for 1.3% of primary cardiac tumors and 0.5% of extranodal lymphomas. However, secondary involvement of the heart is seen in 8.7-27.2% of the documented clinical cases of lymphoma. A 66-year-old man was referred to us for evaluation of dyspnea. A tumor mass was detected by transthoracic and transesophageal echocardiogram in the right atrium. The tumor was surgically resected. The pathologic diagnosis was a malignant lymphoma(diffuse large B cell type) had associated with intracavitary involvement of the right atrium. But acute mediastinitis was developed and then the patient was expired due to sepsis and bleeding at postoperative 9 days.
Aged ; Diagnosis ; Dyspnea ; Heart ; Heart Atria* ; Heart Neoplasms ; Hemorrhage ; Humans ; Lymphoma* ; Mediastinitis ; Sepsis

Deep sternal wound infection (with or without acute mediastinitis) is a serious complication of open heart surgery, with high rates of associated morbidity and mortality, and prolonged hospitallization. The result of treatment largely depends on timely diagnosis and appropriate surgical management. Postoperative deep sternal wound infections in 4 cases were successfully treated with extensive debridement, pressurized jet irrigation with antibiotic solution, sternal refixation by Robicsek method, and dilute antibiotic irrigation via irrigation-suction system. We report 4 cases with review of articles.
Debridement ; Diagnosis ; Heart* ; Mediastinitis ; Mortality ; Sternotomy ; Thoracic Surgery* ; Wound Infection* ; Wounds and Injuries*

Endobronchial leiomyoma is extremely rare and accounts for less than 2% of benign tumors of the lower respiratory tract. Leiomyomas are predominantly found in the young and the middle aged : of the average age being 35 years for bronchial and lung parenchymal lesions and 40.6 years for tracheal lesions. The symptom depends on the location of the tumor, its size, and changes in the lung distal to the lesion. A 37-year-old woman was admitted to our hospital complaining of coughing. Bronchoscopy revealed complete obstruction of the right main bonchus at the carina by an oval-shaped, nonulcerative, smooth, and pinkish-tan tumor with a broad margin and extended to the left main bronchus. A biopsy was performed and showed a benign spindle cell tumor. A right pneumonectomy was performed because of chronic infection, and the lung could not expanded during aeration. The histological diagnosis of the resected specimen was leiomyoma. The postoperative course was uneventful.
Adult ; Biopsy ; Bronchi ; Bronchoscopy ; Cough ; Diagnosis ; Female ; Humans ; Leiomyoma* ; Lung ; Mediastinitis ; Middle Aged ; Pneumonectomy ; Respiratory System

BACKGROUND: Descending necrotizing mediastinitis (DNM) is a life-threatening cervico-mediastinal infection extending from the oropharynx or periodontal space. We reviewed clinical outcomes of DNM patients that underwent surgical management. MATERIAL AND METHOD: We analyzed the demographic and surgical data from 8 patients (6 males and 2 females) that underwent surgical management for DNM between August 2003 and August 2007. RESULT: The mean age was 56.6+/-12.3 (34~72) years. Types of DNM were I (n=2), IIA (n=1), and IIB (n=5), based on the classification system of Endo et al. Four patients were septic at the time of operation. The infectious organism was identified in three cases and turned out to be Streptococcus. ICU stay was 24.3+/-17.9 (3~58) days, and hospital stay was 49.1+/-33.8 (20~125) days. There were two deaths (25%), both of which were due to multi-organ failure. CONCLUSION: Despite aggressive surgical drainage and appropriate medical management, DNM still had a high mortality rate. Early diagnosis and prompt surgical intervention are key to DNM management. In addition, transcervical drainage should be used in limited disease only.
Drainage ; Early Diagnosis ; Humans ; Length of Stay ; Male ; Mediastinitis ; Necrosis ; Oropharynx ; Streptococcus

Although uncommon and rarely reported, tracheo-esophageal perforation during traumatic intubation is life threatening and associated with a high mortality rate. It may result in severe airway complications such as a pneumothorax, pneumomediastium, pneumonia, and mediastinitis. The mortality rate of esophageal perforation has been reported to range from 6 to 34%, and up to 56% if the diagnosis is delayed by more than 12 hours after the event. In our case, the patient had been intubated for 3 weeks with an esophago-tracheal perforation. The perforation was not found by the physician because he had no signs of esophageal perforation, the tip of endotracheal tube was well in the trachea and balloon of the tube was sufficient to prevent air leakage. After the failure of extubation for three times, the diagnosis was carried out by gastrofibroscopy, bronchoscopy and chest 3-dimensional computed tomography. His tracheal and esophageal walls were injured with severe inflammation. Therefore, primary repair could not be done and only a tracheostomy was performed.
Airway Management* ; Bronchoscopy ; Diagnosis ; Esophageal Perforation ; Humans ; Inflammation ; Intubation ; Mediastinitis ; Mortality ; Pneumonia ; Pneumothorax ; Thorax ; Trachea ; Tracheostomy