Mustafa Yaman

Descending necrotizing mediastinitis: a case report

Abstract Descending necrotizing mediastinitis (DNM) is a relatively rare inflammatory pathology with high mortality rates unless an appropriate surgical treatment is undertaken. Early evaluation by means of thoracic computed tomography (CT) scanning is extremely useful for diagnosis and surgical treatment planning. We present a case of DNM in a 38-year-old man. He was admitted to hospital with a history of cough, fever and shortness of breath persisting for 15 days. Physical examination revealed orthopnoea, tachypnoea, and edema of the head and neck. Tonsils and the walls of the hypo- and oropharynx were hyperemic and hypertrophic, and tonsils were covered with an exudative membrane. Plain chest X-ray showed widening of the superior mediastinum. On CT examination there were air and air–fluid levels within mediastinal dense fatty planes that extended from the thoracic inlet to the subcarinal region along the retrotracheal–paraesophageal area. No contrast leakage into the mediastinum was detected with esophagography. Because of suspicion of mediastinitis and worsening of the patient’s symptoms, he underwent right thoracotomy. Widespread purulent material was observed in the middle and posterior mediastinal compartments. Mediastinal drainage, followed by extensive debridement of the necrotic tissue were carried out. Bacteriologic result from materials obtained through the mediastinal drainage yielded methicillin-resistant Staphylococcus aureus. Intravenous antibiotic (glycopeptides) therapy was performed. After the cultures of drained fluid became negative and control CT scan revealed complete regression of the pathologic findings, the patient was discharged from hospital.

A rare benign tumor of the lung: Inflammatory myofibroblastic tumor - Case report.

A fifty year old lady who was operated for thyroid cancer two years ago and completed adjuvant therapy, underwent a computer tomography (CT) of the chest during her follow up. The CT showed a mass lesion in the right lung, located to the lateral segment of the middle lobe. There were no intrabronchial lesions on bronchoscopy. Positron emission CT (PET CT) showed a dense hypermetabolic mass located in the right middle lobe lateral segment and having malignant characteristics. A videothorascopic wedge resection was performed and the specimen was sent for frozen section, which showed no evidence of malignancy. Pathology report revealed an inflammatory myofibroblastic tumor (IMT). Since IMT is a rare benign tumor of the lung, we herein report this patient along with a discussion of the relevant literature.