Endoscopic Ultrasound-Guided Transesophageal Drainage of a Posterior Mediastinal Abscess Secondary to Vertebral Osteomyelitis.

Mediastinal abscesses are life-threatening infections traditionally managed with surgical or percutaneous drainage. Endoscopic ultrasound (EUS)-guided drainage has emerged as a minimally invasive alternative for deep-seated collections, but experience with mediastinal abscesses remains limited. We present a case of successful EUS-guided transesophageal drainage of a posterior mediastinal abscess complicating vertebral osteomyelitis. A 50-year-old man with T3-T4 vertebral osteomyelitis and a posterior mediastinal abscess underwent EUS-guided drainage after percutaneous access was deemed unfeasible. A 19-gauge needle was used for aspiration, followed by guidewire placement and double-pigtail stent insertion. Technical success was achieved with placement of a 7-French × 4-cm double-pigtail stent. Blood and fluid cultures grew methicillin-sensitive Staphylococcus aureus. Complete radiographic resolution was confirmed at 3 days, the stent was removed, and an esophagram on the following day demonstrated no leak. The patient was discharged on a 6-week course of intravenous antibiotics with resolution of all clinical symptoms. EUS-guided drainage with short-interval double-pigtail stent placement is a safe and effective minimally invasive approach for posterior mediastinal abscesses when percutaneous access is not feasible.