胸部大動脈人工血管置換術後に降下性壊死性縦隔炎を合併した1例

Descending Necrotizing Mediastinitis after Graft Replacement of the Thoracic Aorta：Report of a Case

はじめに　降下性壊死性縦隔炎（DNM）は，口腔内感染や咽頭膿瘍などが筋膜間隙や気管周囲間隙に沿って縦隔へ伸展する重篤かつ難治性の感染症であり，非常に致死率が高い1）．われわれは，胸部大動脈人工血管置換術後に本疾患を合併した症例を経験したので報告する．

We report a case of a 64-year-old man with descending necrotizing mediastinitis. He had undergone ascending aortic replacement for Stanford type A acute dissection five years before, and thoracic endovascular aortic repair from the distal arch to the descending aorta for dilation of residual dissection three years before. The patient was admitted to our hospital complaining persistent fever, rubescent neck and chest. Computed tomography （CT） revealed a deep-seated mass extending between the neck and the right upper mediastinum and another mass around the ascending aorta graft. Computed tomography-guided drainage revealed infection of both masses. Surgical debridement, graft replacement, and omental flap transposition were performed. He recovered uneventfully, and no relapse of infection was observed.