is inflammation of the tissues in the mid-chest, or mediastinum. It can be either acute or chronic.
is usually bacterial and due to rupture of organs in the mediastinum. As the infection can progress rapidly, this is considered a serious condition. Chronic sclerosing (or fibrosing) Mediastinitis
, while potentially serious, is caused by a long-standing inflammation of the mediastinum, leading to growth of acellular collagen and fibrous tissue within the chest and around the central vessels and airways. It has a different cause, treatment, and prognosis than acute infectious Mediastinitis
Space infections: Pretracheal space – lies anterior to trachea. Pretracheal space infection leads to Mediastinitis
. Here, the fascia fuses with the pericardium and the parietal pleura, which explains the occurrence of empyema and pericardial effusion in Mediastinitis
Before the development of modern cardiovascular surgery, cases of acute Mediastinitis
usually arose from either perforation of the esophagus or from contiguous spread of odontogenic or retropharyngeal infections. However, in modern practice, most cases of acute Mediastinitis
result from complications of cardiovascular or endoscopic surgical procedures.
Symptoms can mimic pneumonia.
This is a particularly devastating polymicrobial infection involving the neck and below to the mediastinum. It is often caused by an untreated odontogenic infection spreading to the mediastinum. It has a particularly high death rate and can lead to septic shock. The mortality rate is around 10-40% and is usually caused by multi-organ failure. Also, broad spectrum antibiotic therapy and intensive care is required along with the surgery. The culprits are usually Gram-positive bacteria and anaerobes, though rarely, Gram-negative bacteria are also present. This severe form represents 20% of acute Mediastinitis
is usually a radiologic diagnosis manifested by diffuse fibrosis of the soft tissues of the mediastinum. This is sometimes the consequence of prior granulomatous disease, most commonly histoplasmosis. Other identifiable causes include tuberculosis, IgG4-related disease and radiation therapy. Fibrosing Mediastinitis
most frequently causes problems by constricting blood vessels or airways in the mediastinum. This may result in such complications as superior vena cava syndrome or pulmonary edema from compression of pulmonary veins. Fibrosing Mediastinitis
can be similar to fibrothorax.
CT scan can be used.
Treatment for descending necrotizing Mediastinitis
is emergency thoracotomy and mediastinal drainage, combined with broad spectrum IV antibiotics and intensive care monitoring.
Treatment for acute Mediastinitis
usually involves aggressive intravenous antibiotic therapy and hydration. If discrete fluid collections or grossly infected tissue have formed (such as abscesses), they may have to be surgically drained or debrided.
Treatment for chronic fibrosing Mediastinitis
is somewhat controversial, and may include steroids or surgical decompression of affected vessels.