Mediastinitis

Mediastinitis is an inflammation of the mediastinum. The acute mediastinitis usually follows from an esophageal perforation or a median sternotomy. Symptoms include severe chest pain, dyspnea, and fever. The diagnosis is confirmed by chest x-ray or CT. The treatment is done with antibiotics (eg. As with clindamycin plus ceftriaxone) and sometimes surgery.

The two most common causes of acute mediastinitis are

Mediastinitis is an inflammation of the mediastinum. The acute mediastinitis usually follows from an esophageal perforation or a median sternotomy. Symptoms include severe chest pain, dyspnea, and fever. The diagnosis is confirmed by chest x-ray or CT. The treatment is done with antibiotics (eg. As with clindamycin plus ceftriaxone) and sometimes surgery. The two most common causes of acute mediastinitis are esophageal median sternotomy esophageal An esophageal perforation can occur as a complication of esophagoscopy, a Sengstaken-Blakemore probe or Mayo tube (with esophageal varices). Rarely it results from violent vomiting (Boerhaave syndrome). Another possible cause is the swallowing of corrosive substances (for. Example, alkalis, specific button batteries). Certain pills or esophageal ulcers (for. Example, in AIDS patients with esophagitis) can contribute. Patients with esophageal perforation have an acute illness within hours with strong chest pain and dyspnea by the mediastinal inflammation in general. The diagnosis is usually unambiguous because the clinical presentation and Instrumentation history or other risk factors. The diagnosis should also in patients who are very ill, have chest pain and could have a risk factor, they can not describe (z. B. in intoxicated patients who vomited violently, but can not remember it, and at preverbalen children who have swallowed a button battery could) be considered. The diagnosis is confirmed by the detection of air in the mediastinum in the chest x-ray recording or CT. Treatment is with parenteral antibiotics, which should be effective against oral and GI flora (z. B. clindamycin 450 mg iv every 6 h plus ceftriaxone 2 g once daily for at least 2 weeks). Patients who have severe mediastinitis with pleural effusion or pneumothorax, require emergency moderate mediastinal exploration with primary closure of Ösophagusrisses and drainage of the pleura and mediastinum. Median sternotomy at about 1% of cases this procedure occurs due to mediastinitis complications. The patients present most commonly associated with wound drainage or sepsis. The diagnosis based on the detection of infected liquid by aspiration through the sternum. Treatment consists of an immediate surgical drainage, debridement and parenteral broad-spectrum antibiotics. The mortality is up to 50% in some studies. Chronic fibrosing mediastinitis The disease is usually caused by tuberculosis or histoplasmosis, but can also occur in sarcoidosis, silicosis or other fungal diseases. There is a strong fibrotic reaction that can lead to compression of mediastinal structures and the superior vena cava syndrome, a Trachealverengung or obstruction of pulmonary arteries or veins developed. The diagnosis is based on CT. If a tuberculosis based on an anti-tuberculosis therapy is indicated. Otherwise no known treatment is beneficial, but the insertion of vascular or respiratory stents can be considered.

Health Life Media Team

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