mediastinitis

Mediastinitis is inflammation of the mediastinum, the central thoracic space. It is potentially life-threatening and can be acute or chronic. Commonly arises from infection after esophageal perforation or cardiac surgery.

Acute mediastinitis includes esophageal perforation (spontaneous or iatrogenic) and postoperative mediastinitis after sternotomy, as well as rarely trauma or odontogenic infections spreading. Chronic fibrosing mediastinitis results from granulomatous disease such as histoplasmosis or tuberculosis and leads to fibrosis and compression of mediastinal structures.

Symptoms vary: acute forms usually cause fever, chest pain, tachycardia, and sometimes subcutaneous emphysema or sepsis. Esophageal perforation may present with severe chest pain after vomiting and dysphagia. Chronic fibrosing mediastinitis causes dyspnea, cough, or signs of venous obstruction from compression of vessels.

Diagnosis: Chest CT with contrast is the primary imaging tool; X-ray can show mediastinal widening or effusions. Esophagography with water-soluble contrast detects perforation. Blood tests show inflammatory markers.

Treatment: Acute infectious mediastinitis requires urgent IV antibiotics and surgical drainage/debridement. Postoperative mediastinitis similarly needs antibiotics and source control. Chronic fibrosing mediastinitis is managed by treating the underlying condition and relieving compression with stenting or surgery as indicated; steroids or antifungals may be used in selected cases.

Prognosis: Acute mediastinitis carries high mortality if not treated promptly; early recognition and aggressive management improve outcomes.