Case report of a submandibular abscess lethally tracking down through the mediastinum presenting as cardiac empyema

A 46-year-old male presented to our emergency with sudden severe shortness of breath and was found to have massive pericardial effusion causing cardiac tamponade and atrial fibrillation. He had to undergo immediate pericardiocentesis to relieve his symptoms and it drained frank pus indicating pericardial empyema as the underline cause of tamponade. On physical examination, patient was found to have a left submandibular tender swelling. He had increased inflammatory markers and on further imaging the CT showed massive diffuse mediastinal abscess. The patient had to undergo urgent surgery by multiple specialist surgeons in which large amount of pus was drained from the submandibular and mediastinum resulting in improvement of his condition and speeded his recovery. Key Messages • Thorough history and examination are of utmost importance. • Immediate treatment of pericardial tamponade is lifesaving. • High index of suspicion of descending mediastinitis should arise whenever purulent pericardial drainage is encountered. • Early diagnosis of mediastinal abscess by doing early radiographic investigations reduce mortality. • Head and neck abscesses must be treated properly to prevent life-threatening conditions