What Is Mediastinitis?

Mediastinitis is a bacterial infection in the mediastinum, which is clinically divided into acute and chronic. Acute mediastinitis often forms abscesses, which are serious.

Basic Information

English name

mediastinitis

Visiting department

Thoracic Surgery

Common causes

The cause of this disease is mostly secondary, often tuberculosis, histoplasmosis, actinomycetes, syphilis, mediastinal bleeding after trauma, and drug poisoning

Common symptoms

Have chills, high fever, difficulty swallowing, difficulty breathing, pulmonary hypertension, pulmonary vein hypertension, hoarseness, diaphragmatic paralysis, etc.

Causes of mediastinitis

Acute mediastinitis

The etiology of this disease is mostly secondary. Common cases include penetrating chest trauma, esophageal or tracheal rupture, esophageal perforation caused by ingested foreign body, anastomotic fistula after esophageal surgery, perforation of esophageal trauma, and perforation of esophageal cancer ulcer. It often occurs during vomiting, occasionally caused by the direct spread of infections in adjacent tissues such as the posterior esophageal cavity, lungs, pleural lymph nodes, and pericardium.

2. Chronic mediastinitis

It is often caused by tuberculosis, histoplasmosis, actinomycetes, sarcoidosis, syphilis, mediastinal hemorrhage after trauma, and drug poisoning, which can cause mediastinal fibrosis. It may also be related to autoimmunity. The etiology of some patients is unknown.

Clinical manifestations of mediastinitis

Acute mediastinitis may have a related history, typically manifested as acute onset, with chills, high fever, severe pain behind the sternum, and can be radiated to the neck, behind the ears, or between the entire chest and both shoulder blades. On examination, she has shortness of breath, rapid heartbeat, obvious symptoms of systemic poisoning, tenderness in the sternum, enlarged mediastinal dullness, and found mediastinal friction sounds and cracking sounds synchronized with heart sounds. Tracheal displacement and jugular veins may also occur due to compression of the mediastinal structure. Swelling and other symptoms.

Chronic mediastinitis has an insidious course. In the early stages of granulomatous mediastinitis, most of them have no obvious symptoms. After the development of mediastinal fibrosis, symptoms often occur due to invasion or compression of the mediastinal structure, involving the superior vena cava, esophagus, trachea, bronchus, Large pulmonary vessels or mediastinal nerves, etc., produce superior vena cava obstruction, dysphagia, dyspnea, pulmonary hypertension, pulmonary venous hypertension, hoarseness, diaphragmatic palsy, Hornor's sign, etc.

Mediastinitis examination

Laboratory inspection

Peripheral blood like white blood cells and neutrophils count increased.

2. Other inspections

X-ray shows that the mediastinum shadows on both sides are widened, and the upper mediastinum is obvious. The surrounding pleura is affected by inflammation, which makes the contours on both sides blurred. Lateral chest radiographs showed an increase in posterior sternum density and blurred outlines of trachea and aortic arch. When an abscess is formed, a prominent abscess shadow can be seen on one or both sides of the mediastinum, and the trachea and esophagus are compressed and displaced. Mediastinal emphysema, abscess, fluid level, pleural fluid and pneumothorax may also appear. Esophageal iodine oil or organic iodine contrast showed esophageal perforation, esophageal-bronchial fistula, or esophageal pleural fistula.

Mediastinitis diagnosis

According to the medical history and clinical manifestations, combined with auxiliary examination, diagnosis can be made.

Differential diagnosis of mediastinitis

Chronic mediastinitis should be distinguished from central or mediastinal lung cancer and mediastinal malignancies.

Mediastinal Complications

If acute mediastinitis develops into a mediastinal abscess, the clinical manifestations are severe and dangerous, and the mortality rate is high.

Mediastinitis Treatment

Acute mediastinitis

Treatment principles: clear the cause, drain as soon as possible, control infection, nutrition support. Mainly for the primary disease and cause of treatment. For tracheal rupture of mediastinal trauma, tracheal repair is feasible. For patients with esophageal rupture or anastomotic fistula after operation, esophageal repair, fasting fluid and gastrointestinal decompression are feasible. Mediastinal drainage is necessary. For pus culture, the selection of sensitive antibiotics is beneficial for treatment.

2. Chronic mediastinitis

(1) Conservative treatment in internal medicine Take different measures according to different causes, such as using antibiotics to control infection, hormones to promote absorption, diuretics to reduce edema, and low-molecular dextran to promote venous collateral circulation, etc. .

(2) Surgical treatment Surgery establishes a collateral circulation. If the mediastinal fibrotic lesions are limited, the lesion can be removed surgically, the organs can be relieved, and the superior vena cava bypass graft can be performed to reduce the superior vena cava obstruction. The obstructed vein can also be directly opened for thrombectomy, endometrial resection, or bypass surgery using artificial blood vessels, autogenous veins, and allogeneic blood vessels. There is a longitudinal incision in the superior vena cava stenosis abroad, with a large saphenous vein patch repair.