A case of video-assisted thoracoscopic surgery for mediastinal abscess associated with pyogenic spondylitis

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  • 化膿性脊椎炎に併発した縦隔膿瘍の1例

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Abstract

<p>A male in his 80s complaining of fever and neck pain was admitted to a local hospital. Enhanced chest computed tomography revealed bilateral multilocular abscesses around the first and second thoracic vertebrae. Short TI inversion recovery (STIR) and T2-weighted magnetic resonance imaging (MRI) revealed a high signal intensity in the intervertebral discs between the first and second and second and third thoracic vertebrae. In addition, the STIR image revealed a high signal intensity in the first vertebral body. Blood culture yielded methicillin-susceptible Staphylococcus aureus. Based on these findings, the patient was diagnosed with mediastinal abscess caused by purulent spondylitis and sepsis. Since conservative treatment with antibiotics was ineffective, he was referred to our hospital. He underwent bilateral thoracoscopic drainage of the mediastinal abscess 14 days after onset. The inflammatory reaction gradually improved, and the patient was transferred to a different hospital without complications on postoperative day 55.</p><p>Pyogenic spondylitis, which can lead to severe complications including quadriplegia, should be suspected in cases of mediastinal abscesses. MRI is recommended to confirm pyogenic spondylitis in the presence of paraspinal abscess formation on CT, as the findings of pyogenic spondylitis may not be evident on CT.</p>

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