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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 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. Less than 5 percent of patients develop mediastinitis after having chest surgery.
Patients may have a tear in their esophagus that causes mediastinitis. Causes of the tear include:
Other causes of mediastinitis include:
Risk factors include:
- Problems in the upper gastrointestinal tract
- Recent chest surgery or endoscopy
- Weak immune system
Symptoms
- Chest pain
- Chills
- Coughing up blood
- Fever
- Malaise
- Shortness of breath
Signs and tests
Signs of mediastinitis in patients who have had recent surgery include:
- Chest wall tenderness
- Wound drainage
- Unstable chest wall
Tests include:
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 find the source of any 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.
Expectations (prognosis)
How well a person does depends on the cause of the mediastinitis.
Mediastinitis after open 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 mediastinosis 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, Vallières E. Pneumomediastinum and mediastinitis. In: Mason RJ, Murray J, Broaddus VC, Nadel J, eds. Textbook of Respiratory Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2005: chap 72.
Reviewed By: Linda Vorvick, MD, Seattle Site Coordinator, Lecturer, Pathophysiology, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; and Jatin M. Vyas, PhD, MD, Instructor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
