Kyobu geka. The Japanese journal of thoracic surgery
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Case Reports
[Descending necrotizing mediastinitis resulting from acute epiglottitis; report of a case].
Descending necrotizing mediastinitis (DNM) is a serious condition due to abscess spreading from neck into mediastinum. We report a case of DNM following acute epiglottitis and abscess. ⋯ Drainage of mediastinal regions( anterior to the trachea and tracheal bifurcation, inferoposterior mediastinum and posterior to the left main bronchus) was performed on day 14 after hospitalization. Postoperative course was uneventful.
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Acute exacerbation is a devastating and fatal event of hypersensitivity pneumonitis. We report an 80-year-old man with chronic bird fancier's lung which acutely exacerbated after off-pump coronary artery bypass grafting. Our perioperative management included avoidance of inhalation of high concentration oxygen, administration of neutrophil elastase inhibitor, and long-term administration of antibiotics. ⋯ We diagnosed acute exacerbation of hypersensitivity pneumonitis. Immediate steroid pulse therapy with empirical antibiotic administration was effective, and he recovered from critical respiratory failure. High-resolution CT was very helpful in the early detection of acute exacerbation of pneumonitis.