Clinical Case Database / Category: Clinical Care
A mediastinal abscess developing secondary to a gangrenous diabetic toe
Dr Rob J Graham, Dr. Michael Vassallo
Foundation Years Journal, volume 6, issue 1, p.19 (123Doc Education, London, January 2012)
Acute mediastinitis and abscess formation in the anterior mediastinum is rare and carries a high mortality if diagnosed late. A 79 year old gentleman presented with left sided shoulder pain. His past medical history included ischaemic heart disease, type 2 diabetes, and a recent admission for an infected gangrenous diabetic toe. He was found to have a 10cm mass in his left anterior chest wall on computed tomography (CT) imaging. Ultrasound confirmed this to be an abscess. The patient deteriorated and died before the abscess could be drained. A postmortem
confirmed a Staphylococcus aureus anterior mediastinal abscess, and signs of sepsis likely to have developed secondary to haematogenous spread from the infected gangrenous toe.
The case highlights the high mortality of this condition and therefore the need for a high index of suspicion, as early diagnosis and treatment are essential.
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Dr Rob J Graham
Dept. of Medicine
Royal Bournemouth Hospital
Castle Lane East
Dr. Michael Vassallo (Corresponding author)
Dept of Medicine
Royal Bournemouth Hospital
Castle Lane East
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