Mediastinal abscess secondary to left paratracheal deep neck space abscess: a rare presentation and surgical management

Abstract

Deep neck space infections (DNSIs) are potentially life-threatening due to their rapid progression along fascial planes into the mediastinum. Descending mediastinitis, though rare, is associated with significant morbidity and mortality if not managed promptly. We report the case of a 21-year-old male who presented with fever, dysphagia, and neck pain of 10 days’ duration. Clinical examination revealed diffuse anterior neck swelling with tenderness. Contrast-enhanced CT of the neck and chest demonstrated a left paratracheal abscess extending into the posterior mediastinum, along with pleural effusion. Despite prior treatment with intravenous antibiotics at an outside hospital, the infection progressed. The patient underwent incision and drainage of the paratracheal abscess through a midline cervical approach, followed by hemisternotomy for drainage of the mediastinal abscess. Postoperatively, he was managed with broad-spectrum intravenous antibiotics, supportive care, and daily dressings. Secondary suturing was later performed once healthy granulation tissue developed. The patient showed good clinical recovery and was discharged in a stable condition. This case highlights the importance of early diagnosis and aggressive multidisciplinary management of mediastinal extension of DNSIs. Imaging plays a crucial role in delineating the extent of disease, and combined cervical and thoracic surgical drainage is often required for definitive treatment. Mediastinal abscess as a complication of DNSI is rare but potentially fatal. A high index of suspicion, prompt imaging, broad-spectrum antibiotics, and timely surgical drainage through combined approaches are key to successful outcomes.