AM Report Pearls at the SFVA: Mediastinitis

Take-Home Pearls:
– Mediastinitis is an infection of the mediastinal connective tissue that in modern day medicine most often occurs as a postoperative complication of cardiovascular or other thoracic surgical procedures.
– Descending mediastinitis originates in the oral or cervical region and is often caused by continuous spread of odonogenic or retropharyngeal infections.
– Mediastinitis has a very high mortality and requires broad-spectrum antibiotics and urgent surgical intervention.

– Mediastinitis is defined as an infection of the mediastinal connective tissue
– “Descending mediastinitis” is defined as mediastinitis originating from the oral or cervical region

– In modern practice, most cases of mediastinitis are postoperative complications of cardiovascular or other thoracic surgical procedures
– Most cases of “descending mediastinitis” are secondary to contiguous spread of odontogenic or retropharyngeal infections
– Other less common causes of “descending mediastinitis” include:
– traumatic endotracheal intubation
– cervical lymphadenitis
– clavicular osteomyelitis
– external trauma
One cause of mediastinitis we reviewed today was transbronchial needle aspiration

Clinical Manifestations of Mediastinitis:
– fever/chills
– tachycardia
– chest pain
– dyspnea
– leukocytosis

Radiographic Findings:
CT scans are better than plain radiographs in revealing the hallmark characteristics of mediastinitis:
– localized mediastinal fluid collections
– pneumomediastinum

Treatment of mediastinitis requires both broad-spectrum antibiotics and immediate surgical intervention.

Antibiotic therapy should include coverage against gram-positive organisms (including MRSA) and gram-negative bacilli (e.g. vancomycin & third-generation cephalosporin)

Mediastinitis is associated with a very high mortality rate (estimated between 12-50 percent; the mortality rate may vary depending upon whether it is post-operative versus non-postoperative).

Parker KL, Bizekis CS, Zervos MD.  Severe mediastinal infection with abscess formation after endobronchial ultrasound-guided transbronchial needle aspiration.  Ann Thorac Surg 2010;89:1271-72.

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