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Mediastinitis

Chest infection

 

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

Causes

 

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

A person 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:

  • A fungal infection called histoplasmosis
  • Radiation
  • Inflammation of the lymph nodes, lungs, liver, eyes, skin, or other tissues (sarcoidosis)
  • Tuberculosis
  • Breathing in anthrax
  • Cancer

Risk factors include:

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

 

Symptoms

 

Symptoms may include:

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

Signs of mediastinitis in people who have had recent surgery include:

  • Chest wall tenderness
  • Wound drainage
  • Unstable chest wall

 

Exams and Tests

 

The health care provider will perform a physical exam and ask about symptoms and medical history.

Tests may include:

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

The 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, if present.

 

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 and severity of the mediastinitis.

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

 

Possible Complications

 

Complications include the following:

  • Spread of the infection to the bloodstream, blood vessels, bones, heart, or 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 provider if you have had open chest surgery and develop:

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

If you have a lung infection or sarcoidosis and develop any of these symptoms, see your provider right away.

 

Prevention

 

To lessen the risk of developing mediastinits related to chest surgery, surgical wounds should be kept clean and dry after surgery.

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

 

 

References

Cheng GS, Varghese TK, Park DR. Pneumomediastinum and mediastinitis. In: Broaddus VC, Mason RJ, Ernst JD, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 6th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 84.

Van Schooneveld TC, Rupp ME. Mediastinitis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, Updated Edition. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 87.

 
  • Respiratory system

    Respiratory system - illustration

    Air is breathed in through the nasal passageways, travels through the trachea and bronchi to the lungs.

    Respiratory system

    illustration

    • Respiratory system

      Respiratory system - illustration

      Air is breathed in through the nasal passageways, travels through the trachea and bronchi to the lungs.

      Respiratory system

      illustration


     

    Review Date: 7/31/2016

    Reviewed By: 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, Boston, MA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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