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Descending necrotizing mediastinitis (DNM) is a rare disease and mainly related to the spread of oropharyngeal and odontogenic infections into the mediastinum. DNM is a life-threatening disease with a reported mortality of 40-50%. The mainstays of treatment of DNM are surgical drainage and appropriate antibiotic therapy. However, there are a lot of speculations concerning the ideal form of surgical approach in the patients with DNM. We report a case of DNM secondary to Ludwig’s angina with fistula to the left pleural cavity. The drainage of the mediastinum was achieved by the computed tomography guided catheter. The left pleural cavity was also drained by percutaneous catheter. A thorax computed tomography obtained one year after the treatment revealed no sequela. We think that, if the patient is in good condition, even complicated DNM can be treated without aggressive surgery.