PP124 HIDING IN PLAIN SIGHT – A CASE OF DESCENDING MEDIASTINITIS FOLLOWING AN ATRAUMATIC RETROPHARYNGEAL ABSCESS.

Abstract

Descending mediastinitis is one of the most highly lethal complications of atraumatic retropharyngeal abscess (RPA) and associated with a high mortality rate (1, 2). Careful clinical and radiological evaluation are of great diagnostic value, catalysing aggressive treatment to prevent a catastrophic outcome. We report a case of a 45-year-old gentleman presented with 5 days history of a sore throat, odynophagia and fever. The diagnosis of retropharyngeal abscess with posterior mediastinum extension was confirmed by a CT scan. Early intubation was performed in operating theatre and he was successfully treated with surgical drainage of the abscess. A severe infection of the retropharyngeal space can spread downward into the posterior mediastinal area and cause a highly lethal complication (2). The clinical signs are pretty obscured in most cases and only manifest in a handful of patients making the diagnosis a challenge to the physician. Persistent clinical signs such as fever, sore throat, odynophagia and leucocytosis are important clues (3). CT imaging is valuable in evaluating deep neck abscess and predicting the spread of infection. Prompt surgical drainage, appropriate antibiotic therapy and supportive medical care in ICU may signicantly reduce the mortality rate in patient with descending mediastinitis.