二度の両側胸腔鏡下ドレナージ術を要した膿胸を伴う降下性壊死性縦隔炎の1例

Descending Necrotizing Mediastinitis with Empyema Necessitated Two Performances of Surgical Drainage for Successful Treatment：Report of a Case

はじめに　降下性壊死性縦隔炎（DNM）は，口腔や咽喉頭部などの深頸部感染症が縦隔へと波及することにより発症する，致死率の高い比較的まれな疾患である．われわれは，咽頭後壁膿瘍から発症した膿胸を伴うDNMを経験したので報告する．

The case was a 57-year-old woman. She visited a local doctor with a chief complaint of sore throat. A retropharyngeal abscess was suspected, and she was referred to our otolaryngology. Contrast-enhanced computed tomography （CT） scan revealed continuous fluid retention from the retropharyngeal space to the neck and the superior and posterior mediastinum with bilateral pleural effusion. The patient was diagnosed with descending necrotizing mediastinitis with empyema, and on the same day cervical drainage, thoracoscopic bilateral mediastinal drainage, empyema curettage and tracheostomy was performed. Postoperative contrast-enhanced CT scan revealed a widespread residual mediastinal abscess and thoracoscopic bilateral mediastinal drainage was performed again on the 11th postoperative day. After reoperation, the inflammation gradually subsided and she was discharged 47 days after reoperation.