Summary about Disease
Mediastinitis is an inflammation of the mediastinum, the space in the chest between the lungs that contains the heart, esophagus, trachea, major blood vessels, and lymph nodes. It is a serious condition that can be life-threatening if not promptly treated. Mediastinitis can be acute or chronic. Acute mediastinitis usually results from a surgical complication, esophageal perforation, or less commonly, the spread of infection from the neck or lungs. Chronic mediastinitis is often caused by granulomatous diseases like tuberculosis or histoplasmosis, or fibrosing mediastinitis.
Symptoms
Symptoms of mediastinitis can vary depending on the cause and severity of the inflammation. Common symptoms include:
Severe chest pain (often described as substernal)
Fever
Chills
Rapid heart rate (tachycardia)
Rapid breathing (tachypnea)
Difficulty swallowing (dysphagia)
Shortness of breath (dyspnea)
Cough
Hoarseness
Neck pain or swelling
Signs of sepsis (in severe cases)
Causes
The causes of mediastinitis can be broadly categorized as:
Post-surgical: Most commonly occurs after cardiac surgery (e.g., coronary artery bypass grafting, valve replacement).
Esophageal perforation: Can result from endoscopy, surgery, Boerhaave syndrome (spontaneous rupture), or foreign body ingestion.
Spread of infection: From adjacent structures such as the neck (e.g., deep neck infections), lungs (e.g., pneumonia, empyema), or pleura.
Trauma: Blunt or penetrating trauma to the chest.
Less common causes: Mediastinal tumors, radiation therapy, granulomatous diseases (e.g., tuberculosis, histoplasmosis), fibrosing mediastinitis (often idiopathic or related to autoimmune conditions).
Medicine Used
The treatment of mediastinitis typically involves a combination of:
Antibiotics: Broad-spectrum antibiotics are administered intravenously to combat the infection. Specific antibiotics depend on the suspected or identified causative organism. Examples include vancomycin, clindamycin, cefepime, and metronidazole.
Surgical debridement: Removal of infected or necrotic tissue in the mediastinum. This is crucial in cases of post-surgical mediastinitis or when there is significant tissue damage.
Drainage: Drainage of any mediastinal abscesses or fluid collections.
Supportive care: Includes pain management, fluid resuscitation, respiratory support (e.g., mechanical ventilation), and nutritional support.
Antifungal medications: In cases caused by fungal infections.
Is Communicable
Mediastinitis itself is not communicable. It is typically caused by infection within the body or as a complication of medical procedures. The underlying infection that leads to mediastinitis (such as a lung infection) may be communicable, but the mediastinitis itself is not directly transmitted from person to person.
Precautions
Precautions vary depending on the cause of mediastinitis. General precautions include:
Strict adherence to sterile techniques: During surgical procedures to minimize the risk of post-surgical mediastinitis.
Prompt treatment of infections: Addressing infections in the neck, lungs, or other areas that could potentially spread to the mediastinum.
Careful management of esophageal disorders: To prevent esophageal perforation.
Good wound care: Following surgery, to prevent infection.
In healthcare settings: Standard infection control practices to prevent the spread of any underlying infections.
How long does an outbreak last?
Mediastinitis is not an outbreak-related disease. It is an individual condition that develops as a result of specific causes. The duration of the illness varies depending on the cause, severity, and response to treatment. With prompt and appropriate treatment, recovery can take weeks to months. Without treatment, it can be rapidly fatal.
How is it diagnosed?
Diagnosis of mediastinitis typically involves:
Clinical evaluation: Assessing symptoms, medical history (especially recent surgery or esophageal procedures), and physical examination findings.
Imaging studies:
Chest X-ray: Can reveal mediastinal widening, air-fluid levels, or other abnormalities.
CT scan with contrast: Provides detailed images of the mediastinum, allowing for visualization of abscesses, fluid collections, or esophageal perforations.
MRI: Can be used to evaluate the extent of inflammation and identify complications.
Blood tests:
Complete blood count (CBC): May show elevated white blood cell count, indicating infection.
Blood cultures: To identify any bacteria in the bloodstream.
Mediastinal fluid aspiration: If a fluid collection is present, aspiration and analysis of the fluid can help identify the causative organism.
Esophagography or esophagoscopy: May be performed to evaluate for esophageal perforation.
Timeline of Symptoms
The timeline of symptoms varies depending on the cause and severity of the mediastinitis:
Acute post-surgical mediastinitis: Symptoms typically develop within days to weeks after surgery.
Esophageal perforation: Symptoms usually appear abruptly after the perforation.
Spread of infection: Symptoms may develop gradually as the infection spreads from adjacent structures.
Initial Symptoms (all types): fever, chills, chest pain
Within hours to days (if untreated): worsening chest pain, difficulty breathing, signs of sepsis.
Important Considerations
Mediastinitis is a serious and potentially life-threatening condition requiring prompt diagnosis and treatment.
Early surgical intervention (debridement and drainage) is often critical in cases of post-surgical mediastinitis and those with significant tissue damage or abscess formation.
Prolonged antibiotic therapy is usually necessary.
Complications of mediastinitis can include sepsis, pericarditis, empyema, and death.
Patients who have undergone cardiac surgery or have a history of esophageal perforation should be monitored closely for signs and symptoms of mediastinitis.
Fibrosing mediastinitis has a distinct etiology and presentation, and requires a different diagnostic and therapeutic approach than acute bacterial mediastinitis.