Clinical Case Database / Category: Clinical Care

A mediastinal abscess developing secondary to a gangrenous diabetic toe

Publication details

Dr Rob J Graham, Dr. Michael Vassallo
Foundation Years Journal, volume 6, issue 1, p.19 (123Doc Education, London, January 2012)


Acute mediastinitis and abscess formation in the anterior mediastinum is rare and carries a high mortality if diagnosed late. A 79 year old gentleman presented with left sided shoulder pain. His past medical history included ischaemic heart disease, type 2 diabetes, and a recent admission for an infected gangrenous diabetic toe. He was found to have a 10cm mass in his left anterior chest wall on computed tomography (CT) imaging. Ultrasound confirmed this to be an abscess. The patient deteriorated and died before the abscess could be drained. A postmortem
confirmed a Staphylococcus aureus anterior mediastinal abscess, and signs of sepsis likely to have developed secondary to haematogenous spread from the infected gangrenous toe.

The case highlights the high mortality of this condition and therefore the need for a high index of suspicion, as early diagnosis and treatment are essential.

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Dr Rob J Graham

Dept. of Medicine
Royal Bournemouth Hospital
Castle Lane East

Dr. Michael Vassallo (Corresponding author)

Dept of Medicine
Royal Bournemouth Hospital
Castle Lane East


1. Marinella M. Pneumococcal Abscess manifesting as an Anterior Mediastinal Mass and Fatal Haemoptysis. Southern Medical Journal 1999; 92: 1210-12
2. Komatsu ES, Costa F, Marchese LT: Abscess of the mediastinum. J Paed Surg 1989; 24:1125
3. McClelland RN. Non-cardiac thoracic surgery. Selected readings in General Surgery 1998; 25:55
4. Carrol CL, Jeffrey RB Jr, Federle MP. CT evaluation of mediastinal infections. J. Comput Assist Tomogr. 1987 May-Jun; 11(3):449-54
5. Benezra C, spurgeon L, Light RW. Mediastinal abscess secondary to vertebral oseomyelitis. Postgrad Med. 1982 Mar;71(3):220-3
6. Pane GA, Hamilton GC, Call E: Nontraumatic supparitive mediastinitis presenting as acute mediastinal widening. Ann Emerg Med 1983; 12:528-532
7. Masot-Duuch K. Intractable Hiccups; the Role of Cerebral MR in Cases without systemic Cause. AJNR Am J Neuroradiol Nov 199516;2093-2100
8. Gevenois PA, Sergent G. CT-guided percutaneous drainage of an Anterior Mediastinal Abscess with a 16F Catheter. Eur Resp J. 1995 May ;8(5):869-70
9. Smith A, Sinzobahamyva N: Anterior mediastinal abscess complicating septic arthritis. J Paed Surg 1992;27:101-102


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T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

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