Conservative Management of Acute Nontraumatic Mediastinitis in Children: A Case Series.

Acute nontraumatic mediastinitis is a rare and potentially life-threatening condition. In children, management strategies remain poorly standardized. Here, we describe four pediatric cases: two originating from cervical infections (descending necrotizing mediastinitis [DNM]) and two with indeterminate source. The first two patients presented with febrile otorhinolaryngologic symptoms, one complicated by secondary respiratory failure and the other by possibly toxin-related symptoms. The third presented with varicella and scarlet fever-like rash, complicated by multiorgan involvement secondary to a probable toxic shock syndrome. The fourth case presented with fever without focus and shoulder pain. Three patients developed secondary pleural effusions. In three cases, diagnosis was confirmed by computed tomography (CT) scan and in one case by MRI. None had necessitated surgical drainage. All patients were managed conservatively with prolonged antibiotic therapy and achieved complete recovery without sequelae. These cases suggest that, in selected pediatric patients, a conservative, antibiotic-based approach can be both safe and effective.