Mediastinitis
Key points
- Mediastinitis involves inflammation of the mediastinum, the cavity between the lungs.
- Mediastinitis may occur suddenly (acute) or may develop slowly, progressing over time (chronic).
- Signs of mediastinitis include chest wall tenderness, wound drainage, and an unstable chest wall in patients who have had recent surgery.
- If you have an infection, your provider will probably prescribe antibiotics.
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:
Written and revised by
Gerald Hurowitz, M.D.
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