Descending necrotizing mediastinitis: unique complication of central venous catheterization.

Background: Central venous catheter placement is a common procedure in the intensive care unit. However, these devices are not without complications. We describe the first reported case of descending necrotizing mediastinitis secondary to central venous catheterization without evidence of associated vascular perforation.

Methods: Case report and literature review.

Results: A 24-year-old man developed descending necrotizing mediastinitis after exploratory laparotomy for a gunshot wound. A central venous catheter was presumed to be the source because blood, intraoperative, and catheter tip cultures grew the same Klebsiella organism, and there was no evidence of venous perforation at the initial operation.

Conclusions: Prompt recognition, adequate operative drainage, and appropriate antibiotics remain the best treatment for descending necrotizing mediastinitis.