A Case of Deep Neck Abscess Extending to the Waist Area

Deep neck abscess refers to formation of an abscess due to inflammation of the facial spaces in the head and neck area. Deep neck infection could be complicated by descending necrotizing mediastinitis when the inflammation spreads downward, but extension of the inflammation to the back and waist area is rarely observed. We report a rare case of a deep neck abscess in which the inflammation extended to the waist area. A 48-year-old man visited a neighborhood doctor complaining of neck swelling and fever. He was referred to our department with the suspected diagnosis of acute parotitis. We hospitalized the patient with a diagnosis of deep neck abscess, and performed emergent neck incisional drainage and tracheotomy. However, his inflammatory marker levels remained high, and a contrast-enhanced CT performed 6 days after the surgery showed that the abscesses now extended from the deep neck spaces and trapezius muscle to the parasternal region, erector spinae muscle, and lower right quadrant of the abdomen. We performed additional incisional drainage and thoracoscopic drainage jointly with thoracic surgeons, while continuing the antibiotic treatment. The abscesses gradually reduced in size after the last operation, and the patient was discharged home after 50 days of hospitalization. It is uncommon for a deep neck abscess to progress beyond the mediastinum to the waist area. However, if the general condition of a patient with a deep neck abscess does not improve with drainage by the cervical approach alone, it is necessary to conduct imaging examinations as soon as possible and perform appropriate incisional drainage with the cooperation of other departments.