Clin Exp Emerg Med.  2017 Sep;4(3):182-185. 10.15441/ceem.16.197.

Descending necrotizing mediastinitis after a trigger point injection

• Choe JY
• Kim JK
• Lee DE
• Seo KS
• Park JB
• Lee MJ
• Ryoo HW
• Ahn JY
• Moon S

• KMID: 2401248
• DOI: http://doi.org/10.15441/ceem.16.197

Abstract

Descending necrotizing mediastinitis (DNM) is a rare form of mediastinal infection. Most cases are associated with esophageal rupture. DNM after a trigger point injection in the upper trapezius has not been described previously. We present a case of DNM after a trigger point injection in the upper trapezius. A 70-year-old man visited the emergency department with chest discomfort and fever after a trigger point injection in the left upper trapezius. Chest computed tomography showed evidence of DNM, and antibiotic therapy was immediately administered intravenously. Because of the risk of sudden death, poor prognosis due to underlying disease, and his age, he declined surgical treatment and died of septic shock. Although trigger point injections are generally considered safe, caution should be used in patients with an underlying disease or in the elderly. Early diagnosis, broad-spectrum antibiotics, and aggressive surgical management are essential to improve the prognosis.

Keyword

Mediastinitis; Injections; Intramuscular; Tomography, X-ray computed

MeSH Terms

Aged
Anti-Bacterial Agents
Death, Sudden
Early Diagnosis
Emergency Service, Hospital
Fever
Humans
Mediastinitis*
Prognosis
Rupture
Shock, Septic
Superficial Back Muscles
Thorax
Tomography, X-Ray Computed
Trigger Points*
Anti-Bacterial Agents