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Cervical necrotising fasciitis with descending necrotising mediastinitis
  1. Y M Bhatt,
  2. M Small
  1. Department of Otolaryngology, Head and Neck Surgery, Royal Preston Hospital, Fulwood, Preston, Lancashire, UK
  1. Correspondence to Y M Bhatt, Specialist Registrar in Otolaryngology Head and Neck Surgery, Department of Otolaryngology, Head and Neck Surgery, Royal Preston Hospital, Fulwood, Preston, Lancashire PR2 9HT, UK; bhatt_ym{at}yahoo.co.uk

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Case report

A previously healthy 77-year-old man presented with difficulty in swallowing saliva following a 4-day history of sore throat. He was dysphonic with an indurated cellulitic fullness in the left lateral aspect of his neck. Nasendoscopy demonstrated ipsilateral pharyngeal wall swelling and contralateral laryngeal deviation. Contrast-enhanced CT examination demonstrated gas and fluid in the pretracheal and left perivascular deep neck spaces (figure 1A), in keeping with infection caused by gas-forming organisms. The gas and fluid tracked into the superior and anterior mediastinum with an associated mediastinal collection (figure 1B). Transcervical drainage confirmed malodorous dishwater-type fluid and grey necrotic …

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