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    Mediastinitis

    Chest infection

    Mediastinitis is swelling and irritation (inflammation) of the area between the lungs (mediastinum). This area contains the heart, large blood vessels, windpipe (trachea), esophagus, thymus gland, lymph nodes, and connective tissues.

    Causes

    Mediastinitis is usually results from an infection. It may occur suddenly (acute) or may develop slowly and get worse over time (chronic). It most often occurs in patients who recently had an upper endoscopy or chest surgery.

    Patients may have a tear in their esophagus that causes mediastinitis. Causes of the tear include:

    • A procedure such as endoscopy
    • Forceful or constant vomiting
    • Trauma

    Other causes of mediastinitis include:

    • Anthrax inhalation
    • Cancer
    • Histoplasmosis
    • Radiation
    • Sarcoidosis
    • Tuberculosis

    Risk factors include:

    • Disease of the esophagus
    • Diabetes
    • Problems in the upper gastrointestinal tract
    • Recent chest surgery or endoscopy
    • Weakened immune system

    Symptoms

    • Chest pain
    • Chills
    • Fever
    • General discomfort
    • Shortness of breath

    Exams and Tests

    Some of the signs of mediastinitis in patients who have had recent surgery include:

    • Chest wall tenderness
    • Wound drainage
    • Unstable chest wall

    Tests include:

    • Chest CT scan or MRI scan
    • Chest x-ray

    Your health care provider may insert a needle into the area of inflammation and remove a sample to send for gram stain and culture to determine the type of infection.

    Treatment

    You may receive antibiotics if you have an infection.

    You may need surgery to remove the area of inflammation if the blood vessels, windpipe, or esophagus is blocked.

    Outlook (Prognosis)

    How well a person does depends on the cause of the mediastinitis.

    Mediastinitis after chest surgery is very serious. There is a significant risk of dying from the condition.

    Possible Complications

    Complications include the following:

    • Spread of the infection to the:
      • Bloodstream
      • Blood vessels
      • Bones
      • Heart
      • Lungs
    • Scarring

    Scarring can be severe, especially when it is caused by chronic mediastinitis. Scarring can interfere with heart or lung function.

    When to Contact a Medical Professional

    Contact your health care provider if you have had open chest surgery and develop:

    • Chest pain
    • Chills
    • Drainage from the wound
    • Fever
    • Shortness of breath

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

    Prevention

    The only way to prevent this condition related to chest surgery is to keep surgical wounds clean and dry after surgery.

    Treating tuberculosis, sarcoidosis, or other conditions associated with mediastinitis may prevent this complication.

    References

    Park DR, Vallieres E. Pneumomediastinum and mediastinitis. In: Mason RJ, Broaddus VC, Martin TR, et al.. Murray & Nadel’s Textbook of Respiratory Medicine. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2010: chap 77.

    Celli BR. Diseases of the diaphragm, chest wall, pleura, and mediastinum. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 99.

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    • Respiratory system

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      • Respiratory system

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      Review Date: 8/15/2012

      Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.

      The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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