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Descending necrotising mediastinitis (DNM) is an uncommon clinical entity which may arise secondary to primary odontogenic or neck infection in susceptible patients. Infection may spread contiguously via the alar or 'danger' space, a potential anatomical space posterior to the true retropharyngeal space. 1 Spread of infection to the mediastinum almost always necessitates urgent cardiothoracic surgical intervention. 2-4 This case report describes a male patient whose clinical deterioration following the diagnosis of submandibular abscess was investigated with CT imaging of the chest, where a diagnosis of DNM was made. Diagnosis was confirmed following surgical intervention and aspiration of pus from the mediastinum.

Taking heed of the ‘danger space’: acute descending necrotising mediastinitis secondary to primary odontogenic infection