Two cases of necrotizing descending mediastinitis who underwent succesful mediastinal drainage by a thracoscopic approach *
In case 1, a 69-year-old male with mediastinitis caused by phlegmon occurring in the left lower jaw was referred to our Department of Thoracic Surgery. A CT scan revealed an abscess in the retropharyngeal space that had extended to the right upper and the left posterior mediastinum. Bilateral pleural effusion was also identified. A diagnosis of necrotizing descending mediastinitis was made, and therefore mediastinal drainage through the right thoracic cavity was performed. First, a chest tube was inserted into the left thoracic cavity to drain the effusion and to maintain safe intraoperative one lung ventilation. The effusion was serous in appearance and was considered to be not infected. Thoracoscopic exploration of the right thoracic cavity revealed a large quantity of pus in the upper mediasitnium, and mediastinal drainage was performed. Although a reoperation was needed to drain the remaining abscess in the right thoracic cavity, therefore the mediastinitis recovered. In case 2, a 20-year-old male with mediastinitis that had been caused by sinusitis on his left side was referred to our department. A CT scan revealed an abscess in the left paraesophageal space extending to the both sides of the posterior mediastinum. Bilateral pleural effusion was present. After a chest tube was inserted into the right thoracic cavity, thoracoscopic mediastinal drainage was performed through the left thoracic cavity. The postoperative course was good. We herein describe two cases of necrotizing descending mediastinitis with bilateral effusion, which were controlled by thoracoscopic mediastinal drainage.（Accepted on August 14，2007）
