Mediastinitis

Alternative names
Chest infection

Definition
Mediastinitis involves inflammation of the mediastinum, the cavity between the lungs. The mediastinum contains the heart, the large vessels, the trachea, the esophagus, the thymus, and connective tissues.

Causes, incidence, and risk factors

Mediastinitis may occur suddenly (acute) or may develop slowly, progressing over time (chronic). The majority of cases occur in patients who have had open chest surgery. This complication occurs in less than 5 percent of all patients who have open chest surgery.

Patients who have a tear in their esophagus - either from excessive vomiting, trauma, or endoscopy - may also develop mediastinitis. Chronic or slowly developing mediastinitis may arise from tuberculosis, histoplasmosis, other fungal infections, cancer, or sarcoidosis.

Risk factors include recent chest surgery or endoscopy, problems in the upper gastrointestinal tract, and having an impaired immune system.

Symptoms

     
  • Fever  
  • Chills  
  • Chest pain  
  • Shortness of breath  
  • Malaise

Signs and tests

Signs of mediastinitis include chest wall tenderness, wound drainage, and an unstable chest wall in patients who have had recent surgery. A chest x-ray may show a widened mediastinum, caused by the collection of inflammatory cells within the chest.

A chest CT scan may show a more detailed view of the mediastinitis. Your health care provider may insert a needle into the area of inflammation and withdraw a sample to send for Gram stain and culture to identify the source of any infection.

Treatment

If you have an infection, your provider will probably prescribe antibiotics. You may be given broad-spectrum antibiotics to start with, and switched to a more specific antibiotic once the type of bacteria causing the infection is determined. This decreases the risk of side effects from the medication.

Often patients with mediastinitis must undergo surgery to debride (remove) the area of inflammation.

Expectations (prognosis)

Prognosis depends on the cause. Patients who develop mediastinitis after open chest surgery have a significant risk of death as a result of the condition.

Complications

Complications include the following:

     
  • Spread of the infection to surrounding structures:       o Heart       o Great vessels       o Lungs       o Bones  
  • Spread of the infection to the bloodstream  
  • Scarring

Scarring can be severe, especially when caused by chronic mediastinitis, and can compromise heart or lung function.

Calling your health care provider

Contact your provider if you have had open chest surgery and develop chest pain, fevers, chills, shortness of breath, or drainage from the incisions.

If you have tuberculosis or sarcoidosis and develop any of these symptoms, contact your provider right away.

Prevention

The only way to prevent mediastinosis related to chest surgery is to keep surgical incisions clean and dry after surgery.

Treatment of underlying tuberculosis, sarcoidosis, or other condition associated with mediastinitis may prevent this complication.

Johns Hopkins patient information

Last revised: December 2, 2012
by Arthur A. Poghosian, M.D.

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