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Mediastinitis

Definition

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

Alternative Names

Chest infection

Causes, incidence, and risk factors

Mediastinitis may occur suddenly (acute) or may develop slowly and get worse over time (chronic). Most cases occur in patients who have had open chest surgery. This complication occurs in less than 5 percent of all patients who have open chest surgery.

Patients who have a tear in their esophagusr from excessive vomiting, trauma, or endoscopy may also develop mediastinitis. Other causes of mediastinitis include tuberculosis, histoplasmosis, cancer, and sarcoidosis.

Risk factors include recent chest surgery or endoscopy, problems in the upper gastrointestinal tract, and a weak immune system

Symptoms

• Fever
• Chills
• Chest pain
• Shortness of breath
• Malaise

Signs and tests

Signs of mediastinitis include chest wall tenderness, wound drainage, and an unstable chest wall in patients who have had recent surgery. A chest x-ray may show a widened mediastinum, caused by the collection of white blood cells within the chest.

A chest CT scan may show a more detailed view of the mediastinitis. Your health care provider may insert a needle into the area of inflammation and withdraw a sample to send for gram stain and culture to identify the source of any infection.

Treatment

You may receive antibiotics if you have an infection. Often, patients with mediastinitis must have surgery to debride (remove) the area of inflammation.

Expectations (prognosis)

How well a person does depends on the cause of the mediastinitis. Patients who develop mediastinitis after open chest surgery have a significant risk of dying from the condition.

Complications

Complications include the following:

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

Scarring can be severe, especially when caused by chronic mediastinitis, and 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, fevers, chills, shortness of breath, or drainage from the wound.

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

Prevention

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

Treatment of underlying tuberculosis, sarcoidosis, or other condition associated with mediastinitis may prevent this complication.

Review Date:7/28/2006
Reviewed By:Charlotte Grayson, MD, Private Practice specializing in Internal Medicine and Infectious Disease, Smyrna, GA. Review provided by VeriMed Healthcare Network.

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