Atypical Extension to the Chest Wall of Descending Necrotizing Mediastinitis: A Rare Case in a 16-Year-Old Woman

TL;DR

A 16-year-old woman developed a rare chest wall extension of a severe throat infection, requiring urgent surgery and intensive care.

Contribution

Reports a rare atypical extension of descending necrotizing mediastinitis to the chest wall in a young patient.

Findings

DNM originated from an odontogenic infection and spread unusually to the chest wall.

Anti-inflammatory drugs delayed symptom recognition, complicating diagnosis.

Aggressive surgical debridement and multidisciplinary care led to a successful recovery.

Abstract

Descending necrotizing mediastinitis (DNM) is a severe and life-threatening infection requiring urgent diagnosis and aggressive management. We present the case of a 16-year-old woman with no prior medical history who developed DNM following an odontogenic infection, complicated by an unusual and rare extension to the chest wall. Such an atypical spread of infection is infrequent and poses additional diagnostic and therapeutic challenges. The use of anti-inflammatory drugs likely masked early symptoms, delaying recognition. Imaging confirmed extensive mediastinal involvement, necessitating prompt surgical intervention. The patient underwent aggressive surgical debridement via cervicothoracic approaches, followed by intensive postoperative care, leading to a favorable outcome. This case highlights the importance of early recognition and a multidisciplinary approach in DNM management, particularly when faced with atypical extensions beyond the mediastinum.

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