We estimated reliability of computed tomography scan for early detection of mediastinal infectious inflammation, influence of descending necrotizing mediastinitis type and extent of urgent surgical intervention on final treatment results. A retrospective analysis was completed with clinical experience, involving 19 patients (11 male, 8 female), 38-78 years of age, operated on due to descending necrotizing mediastinitis in 1992-2002. Early diagnosis, using computed tomography scan, and more aggressive surgical management allowed to decrease mortality rate from 85.7 % ( in 1992-1998) to 50.0 % (in 1999-2002). We suggest an algorythm for well-timed diagnosis and complex surgical treatment of descending necrotizing mediastinitis based on results of this study and medical literature review.