Introduction:
Mediastinitis is a severe infection of the mediastinal connective tissue, usually related to direct contamination (esophagic perforation or surgical procedure to the chest). Other possible sources of infection include: hematogenous or lymphatic dissemination and extension of a head/neck infection. The treatment includes long term intravenous administration of antibiotics, but the gold standard treatment is surgical drainage.

Case Report:
A 6-year-old girl presented at the emergency department with a three-day fever (max. 40ºC) associated with thoracoabdominal pain and anorexia that started on that day. Previous history of upper respiratory symptoms including sore throat. Examination revealed a decreased mobility of the neck, respiratory distress, trismus, pharyngitis and bibasilar crackles. Thorax X-ray showed a widened mediastinum and CT revealed a tecidular hypodensity of the mediastinum and mediastinal lymphadenopathies. Laboratory tests: Leucocytosis (31490/uL) with neutrophilia, CRP 34.03 mg/dL. The girl was admitted and broad-spectrum therapy (ceftriaxone, clarithromycin and vancomycin) was initiated. After exclusion of a lymphoproliferative disease a mediastinal infection was assumed. On the fourth day of admission a GAS was isolated from a blood culture and clindamycin was added. She was afebrile since day 6 and the evolution of the mediastinal lesion was monitored with CT scan and ultrasonography that showed progressive decrease of the size. After 4 weeks of intravenous antibiotics, the girl was discharged without any symptoms.

Conclusions:
Mediastinitis is a life-threatening infection and needs an urgent approach. Although surgical treatment is the gold standard, selected cases with good response to antibiotics can be spared from a surgical intervention and its complications.

0907 - Mediastinitis as a complication of a deep cervical infection, a conservative approach.