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Mediastinitis
From WikEM
Contents
Background
- Inflammation of the mediastinum
- Commonly caused by esophageal rupture or perforation
- Infection may be caused by esophageal rupture/perforation or spread of infection from remote site
- Streptococcus and Bacteroides
Etiology
- Prior cardiovascular surgery (most common cause)[1]
- Esophageal rupture (Boerhaave Syndrome)
- Ludwig Angina
- Thoracic Trauma
- Lung infection extension
Clinical Features
- Fever
- Dyspnea
- Chest pain
- Neck pain and swelling
- Crepitus
- Signs of Sepsis
- Hamman sign on auscultation of precordium (crunch heard during systole)
Differential Diagnosis
Evaluation
- CXR - often first modality
- Typically reveals subcutaneous emphysema, widening of the mediastinum and pleural effusions
- CT with IV contrast if diagnosis in doubt
- Septic workup to include:
- CBC
- Lactic acid
- Blood cultures (incl gram Stain)
- Cultures of mediastinal fluid
Management
- Aggressive airway management
- Patients with mediastinitis emergently require surgery
- Consult
- CT Surgery for repair
- ENT if upper neck area
- GI for possible endoscopy
- Consult
- Start broad-spectrum antibiotics to include Pseudomonal coverage[2]
Disposition
- Admit to ICU
See Also
References
- ↑ Infections of the mediastinum. SB - Thorac Surg Clin 2009 Feb; PMID 19288819
- ↑ El Oakley, RM et al. Postoperative mediastinitis: classification and management. Ann Thorac Surg. 1996. PMID 8619682
