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Mediastinitis

Definition

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.

Alternative Names

Chest infection

Causes, incidence, and risk factors

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
• Problems in the upper gastrointestinal tract
• Recent chest surgery or endoscopy
• Weakened immune system

Symptoms

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

Signs 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.

Support Groups

Expectations (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.

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.

Calling your health care provider

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, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 100.