– 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:
– chest pain
CT scans are better than plain radiographs in revealing the hallmark characteristics of mediastinitis:
– localized mediastinal fluid collections
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.