Descending Necrotizing Mediastinitis in an Infant

CASE A nine-month-old girl was brought to the emergency department because of right neck swelling. She had recently been discharged from the same hospital after a brief admission for pneumonia that had followed influenza. The mother denied noticing increased drooling, dyspnea, or stridor. Pooled oral secretions were present on physical exam, but the patient was calm with normal vital signs (Figure 1). Computed tomography (CT) of the neck revealed a large retropharyngeal abscess tracking caudally into the posterior mediastinum (Figure 2). The infection extended into the adjacent right carotid sheath, producing a dramatic “Lincoln’s Highway” sign (Figure 3). Tulane University Medical Center, Department of Internal Medicine, New Orleans, Louisiana Tulane University Medical Center, Department of Pediatrics, New Orleans, Louisiana Tulane University Medical Center, Department of Radiology, New Orleans, Louisiana *