Descending Necrotising Mediastinitis, A Fatal Disease to Keep in Mind

Descending necrotising mediastinitis, a term used by Estrera (1983) [1], is a rare and serious disease requiring prompt diagnosis and immediate aggressive surgical therapy. It should be considered in the differential diagnosis of acute mediastinal widening. We report an unusual case of primary retropharyngeal abscess complicated by descending necrotising mediastinitis and bilateral empyema in a 56-year-old diabetic man. The diagnosis of descending necrotising mediastinitis (DNM) was established by the characteristic findings on computed tomography. The patient was treated by cervicotomy and staged bilateral posterolateral thoracotomy.