Descending Necrotizing Mediastinitis Secondary To Cervical Necrotizing Infection: A Case Report

Descending necrotizing mediastinitis (DNM) is a rare but life-threatening infection characterized by rapid spread of necrotizing infection from the cervical fascial spaces into the mediastinum. Early diagnosis and prompt intervention are essential to reduce mortality, which remains high despite advances in imaging and surgical management. We report the case of a 46-year-old male who presented with high-grade fever and swelling in the right supraclavicular region. Initial clinical evaluation suggested a deep neck infection. Computed tomography (CT) of the neck revealed multiple air locules with soft tissue density and fascial thickening in the right lower cervical region and supraclavicular area. The infection extended inferiorly into the anterior mediastinum and subtle middle mediastinal spaces, consistent with descending necrotizing mediastinitis. The necrotizing mediastinal collection measured approximately 6.5 × 4.9 cm and was noted to abut the superior vena cava near the level of the aortic arch, with loss of fat planes adjacent to the thyroid gland and retrosternal extension. CT imaging played a critical role in delineating the extent of infection and guiding further management. This case highlights the aggressive nature of cervical necrotizing infections and their potential to rapidly descend into the mediastinum. Early recognition using crosssectional imaging and prompt multidisciplinary management are crucial in preventing fatal complications associated with this rare but severe condition.