Acute mediastinitis and abscess are mostly caused by bacterial infection after perforated rupture of esophagus, ulcerated and perforated tracheal tumor, and a few for the spread of septic infection of lungs, pleura, and pericardium, which are mainly symptoms of acute infections: (1) There may be a history of acute suppurative infections of pharynx and neck or various parts of the body. (2) Localized redness, swelling and pain with fluctuating sensation in the infected foci, and pus in the test. (3) Systemic symptoms include chest pain, fever, and malaise. (4) Increased white blood cell count. (5) Deep abscess may show liquid dark area by ultrasound. Esophageal foreign body with perforation is a common clinical trigger. The lower triangle of the cricopharyngeal muscle at the entrance of the esophagus is the weakest and most vulnerable part of the entrance of the esophagus; among the four physiological narrowing parts of the esophagus, the first narrowing (also the entrance of the esophagus) is the most vulnerable to perforation by embedded foreign bodies; here, the air and saliva of the perforated esophagus enters into the jugular fascial space to form a cervical emphysema or abscess, or enters into the posterior mediastinum to form mediastinum emphysema or mediastinum abscess through the jugular fascial space; and the posterior mediastinum contains aorta, thoracic duct, singular artery, common artery, and other organs. The posterior mediastinum contains important blood vessels and nerves such as the aorta, thoracic duct, singular artery, and left recurrent laryngeal nerve. Prolonged immersion of these blood vessels and nerves in the abscess cavity may lead to a series of serious consequences of neurovascular injury. The principle of treatment is still to early inflammation or can take local hot compresses, external application of heat-clearing and detoxifying traditional Chinese medicine, abscess formation can be incised drainage incision pus drainage; the use of sensitive anti-inflammatory elements. Shallow mediastinum drainage effect is relatively good, the mediastinum is deeper and easy for aerobic and anaerobic bacteria co-infection, but the anti-infection is not effective so that the infection is still along the cervical fascial space into the posterior mediastinum, leading to posterior mediastinal abscess, and even broken into the thoracic cavity, because of the mediastinum position is more hidden, lying down mediastinum pus cavity position is low, the infection spreads to the back of the pharynx, pharyngeal parapharyngeal deep cervical fascial space, etc, can be diffused by the plane of the fascial space and due to the gravity, the negative pressure of the chest cavity during respiration. When the infection spreads to the deep cervical fascial space of the posterior pharynx and parapharynx, the infection can spread through the fascial space, and due to gravity, the role of negative pressure in the thoracic cavity during respiration makes it more likely to spread downward and involve the mediastinum, mediastinal drainage through the thoracic cavity, open the drainage trauma after surgery, and parallel flushing, so as to facilitate the entry of air into the infected space to prevent anaerobic bacteria from growing, and reduce the negative pressure in the thoracic cavity to prevent the infection from developing deeper for the reasons of gravity.