Octavio Flores-Calderón

Descending necrotizing mediastinitis associated with spinal cord abscess

A 58-year-old man with a history of Ludwig’s angina was admitted with a spinal cord abscess at the level of C2-T1 and associated osteomyelitic destruction of vertebral bodies, spinal cord compression, and secondary quadriparesis, followed by descending mediastinitis. A right posterolateral thoracotomy and a cervicotomy drained purulent exudates. A tracheostomy was performed, and the patient was discharged after 84 days.

Descending necrotizing mediastinitis and thoracic cellulitis due to varicella

A 22-year-old man with varicella had associated cervical enlargement, right upper thoracic anterior and suprascapular cellulitis, and mediastinitis. A tracheostomy, right posterolateral thoracotomy, cervicotomy, and upper thoracic fasciotomy were performed 14 h after admission, draining purulent exudates from all sites. The patient was discharged on postoperative day 22.

Thoracic necrotizing fasciitis due to snake ointment that progressed to a mediastinitis

We report the case of a 42-year old diabetic male presenting with erythema of the neck and anterior right thoracic region secondary to the application of an ointment derived from rattlesnakes, progressing to a full-blown necrotizing fasciitis in a short period of time, with associated mediastinitis, thrombocytopaenia and sepsis. The patient died despite aggressive multidisciplinary medical and surgical treatment. We present this case due to the unusual aetiology and fulminating course.

Retroperitoneal leiomyoma that infiltrated into the right ventricle

A 49-year-old woman with a history of uterine myomas, moderate hepatic insufficiency, and ascites, was found to have a cardiac murmur. Echocardiography showed dilation of the right atrium, moderate tricuspid insufficiency, and a right atrial mass that advanced on diastole to the apex of the right ventricle, suggesting a myxoma. At surgery, an intracardiac pediculated mass was seen emerging from the lumen of the inferior vena cava. The mass was carefully pulled as far as possible and transected. After histologic and immunohistochemistry studies, the tumor was reported as an extending intracardiac leiomyoma (Figure 1). Postoperative computed tomography revealed a giant retroperitoneal infiltrating mass, discarding the diagnosis of ascites (Figure 2). An abdominal approach is planned.