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Abstract Descending necrotizing mediastinitis is a rare and life-threatening complication of deep neck space infection. An understanding of the anatomy of the deep spaces of the neck and familiarity with the imaging findings in descending necrotizing mediastinitis may allow rapid diagnosis and treatment of this rare complication of neck infections. We review the anatomy of the deep spaces of the neck and the imaging appearance of descending necrotizing mediastinitis in two patients.