Recently, the Department of Thoracic Surgery at Xi'an International Medical Center Hospital successfully treated a patient with descending necrotizing mediastinitis. The successful implementation of the surgery not only saved the patient's life, but also fully demonstrated the hospital's strong ability to rescue critically ill patients.
A week ago, Ms. Wu, who was 30 years old, had a sore throat after eating crabs. She quickly developed neck swelling, high fever, chest tightness, shortness of breath, and was unable to lie flat. She came to Xi'an International Medical Center Hospital for treatment and was diagnosed with: 1. Downward necrotizing mediastinitis (Figure 1 and Figure 2) 2. Neck abscess 3. Empyema (bilateral).

Figure 1

Figure 2

After receiving the patient, the medical team from the three departments of thoracic surgery immediately performed thoracoscopic minimally invasive mediastinal abscess removal and drainage surgery, as well as bilateral thoracic abscess removal and drainage surgery for Ms. Wu overnight. During the surgery, seven life-saving tubes were placed in the mediastinal area and bilateral chest cavities.
What is descending necrotizing mediastinitis? It refers to a purulent infection in the throat or deep neck that spreads downwards through the cervical fascial space, causing mediastinal abscess and necrotic inflammation. This disease is an urgent and severe condition in thoracic surgery, with a dangerous condition, severe infection, rapid spread of lesions, and easy delay in diagnosis and treatment. The mortality rate can be as high as 40-76% or more. If the infection cannot be controlled in a timely manner or the infected area cannot be drained, even in the highly developed era of critical care medicine, the mortality rate of patients still exceeds 40%.
Ms. Wu's condition is even more severe, with the infection not only affecting the neck and mediastinum, but also rapidly spreading to both chest cavities. A large amount of loose connective tissue becomes necrotic after infection, forming an abscess and spreading, resulting in high fever, inability to lie flat, heart rate exceeding 150 beats per minute, followed by septic shock and death.
The best method currently is to remove and fully drain the infected, necrotic tissue and pus from the mediastinum and chest cavity to prevent further spread and expansion of the infection. Director Wang Wuping of the Department of Thoracic Surgery immediately decided to perform emergency surgery overnight for the patient.
Although he had been tirelessly performing four major thoracic surgeries since 9am that day and was already exhausted by 8pm, he still rushed to the operating room. If the patient is delayed until tomorrow, there may be no chance for treatment. Her infection is progressing too quickly, "said Director Wang Wuping.
On that day, with the full cooperation of the anesthesiology department, Director Wang Wuping and Dr. Li Ziliang performed thoracoscopic mediastinal and thoracic purulent removal and adequate drainage for the patient overnight. Three changes in position were made during the surgery, and seven life-saving tubes were placed for the patient (Figure 3). The surgery ended at 5 am.

Figure 3

During the operation, it was found that the patient had extensive pus accumulation and separation in the mediastinum and bilateral chest cavities. The connective tissue and fat in the mediastinum were extensively necrotic, and the structure was difficult to identify. Director Wang Wuping, with his rich clinical experience and skilled techniques, accurately exposed the mediastinal area while protecting important organs and blood vessels in the anterior mediastinum. He thoroughly incised the mediastinal and thoracic abscesses, ensured smooth drainage, and successfully completed the surgery.
Timely and effective surgical removal of abscess and sufficient drainage, combined with strong anti infection and supportive therapy, enabled Ms. Wu's condition to recover smoothly. Upon discharge, Director Wang Wuping's team presented a banner as a gift.
For a long time, the Department of Thoracic Surgery has always regarded medical quality and safety as the foundation of its discipline, pursuing excellence in every medical detail. With excellent diagnosis and treatment level and service quality, it has not only relieved patients of chest diseases, but also won countless praises. The three departments of thoracic surgery are striving to build a "three good" team with warmth, reputation, and emotion.