Descending necrotizing mediastinitis extended to empyema

: A 61-year-old man came to our hospital complained of neck swelling after extracting a tooth. Cervical drainage was performed in the diagnosis of cervical abscess. Two days later, left pleural effusion appeared and its bacteriologic culture showed Streptococcus constellatus. Computed tomography (CT) scan showed massive retained pus in the mediastinum. Thoracic drainage alone wasn't effective and the left thoracotomy was immediately performed to open the mediastinal pleura and curette the thoracic cavity. After surgery, left thoracic cavity was irrigated with a large volume of saline solution via the thoracic drains for a month, resulting in successful recovery. Immediate open drainage and irrigation are very important in case of descending necrotizing mediastinitis rapidly developing empyema.