Mediastinitis: Difference between revisions
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==Background== | ==Background== | ||
* Inflammation of the mediastinum | *Inflammation of the mediastinum | ||
**Commonly caused by esophageal rupture or perforation | **Commonly caused by esophageal rupture or perforation | ||
** | **Infection may be caused by esophageal rupture/perforation or spread of infection from remote site | ||
***Streptococcus and Bacteroides | ***Streptococcus and Bacteroides | ||
===Etiology=== | ===Etiology=== | ||
* Prior cardiovascular surgery (most common cause)<ref>Infections of the mediastinum. SB - Thorac Surg Clin 2009 Feb; PMID 19288819 </ref> | *Prior cardiovascular surgery (most common cause)<ref>Infections of the mediastinum. SB - Thorac Surg Clin 2009 Feb; PMID 19288819 </ref> | ||
* [[Esophageal Perforation|Esophageal rupture (Boerhaave Syndrome)]] | *[[Esophageal Perforation|Esophageal rupture (Boerhaave Syndrome)]] | ||
* [[Ludwig Angina]] | *[[Ludwig Angina]] | ||
* [[Thoracic Trauma]] | *[[Thoracic Trauma]] | ||
* Lung infection extension | *Lung infection extension | ||
==Clinical Features== | ==Clinical Features== | ||
| Line 19: | Line 18: | ||
*[[Neck pain]] and swelling | *[[Neck pain]] and swelling | ||
**Crepitus | **Crepitus | ||
* Signs of [[Sepsis]] | *Signs of [[Sepsis]] | ||
* Hamman sign on auscultation of precordium (crunch heard during systole) | *Hamman sign on auscultation of precordium (crunch heard during systole) | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
== | ==Evaluation== | ||
* | *[[CXR]] - often first modality | ||
**Typically reveals subcutaneous emphysema, widening of the mediastinum and pleural effusions | **Typically reveals subcutaneous emphysema, widening of the mediastinum and pleural effusions | ||
* CT if diagnosis in doubt | *CT with IV contrast if diagnosis in doubt | ||
*Septic workup to include: | |||
**CBC | |||
**Lactic acid | |||
**Blood cultures (incl gram Stain) | |||
**Cultures of mediastinal fluid | |||
==Management== | ==Management== | ||
* | *Aggressive airway management | ||
* ''Patients with mediastinitis emergently require surgery'' | *''Patients with mediastinitis emergently require surgery'' | ||
**Consult | **Consult | ||
***CT Surgery for repair | ***CT Surgery for repair | ||
***ENT if upper neck area | ***ENT if upper neck area | ||
***GI for possible endoscopy | ***GI for possible endoscopy | ||
* Start broad-spectrum antibiotics to include Pseudomonal coverage<ref>El Oakley, RM et al. Postoperative mediastinitis: classification and management. Ann Thorac Surg. 1996. PMID 8619682</ref> | *Start broad-spectrum antibiotics to include Pseudomonal coverage<ref>El Oakley, RM et al. Postoperative mediastinitis: classification and management. Ann Thorac Surg. 1996. PMID 8619682</ref> | ||
==Disposition== | ==Disposition== | ||
* Admit | *Admit to ICU | ||
==See Also== | ==See Also== | ||
| Line 50: | Line 49: | ||
*[[Thoracic Trauma]] | *[[Thoracic Trauma]] | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category:ID]] | [[Category:ID]] | ||
[[Category: | [[Category:Pulmonary]] | ||
Latest revision as of 16:16, 9 September 2016
Background
- Inflammation of the mediastinum
- Commonly caused by esophageal rupture or perforation
- Infection may be caused by esophageal rupture/perforation or spread of infection from remote site
- Streptococcus and Bacteroides
Etiology
- Prior cardiovascular surgery (most common cause)[1]
- Esophageal rupture (Boerhaave Syndrome)
- Ludwig Angina
- Thoracic Trauma
- Lung infection extension
Clinical Features
- Fever
- Dyspnea
- Chest pain
- Neck pain and swelling
- Crepitus
- Signs of Sepsis
- Hamman sign on auscultation of precordium (crunch heard during systole)
Differential Diagnosis
Evaluation
- CXR - often first modality
- Typically reveals subcutaneous emphysema, widening of the mediastinum and pleural effusions
- CT with IV contrast if diagnosis in doubt
- Septic workup to include:
- CBC
- Lactic acid
- Blood cultures (incl gram Stain)
- Cultures of mediastinal fluid
Management
- Aggressive airway management
- Patients with mediastinitis emergently require surgery
- Consult
- CT Surgery for repair
- ENT if upper neck area
- GI for possible endoscopy
- Consult
- Start broad-spectrum antibiotics to include Pseudomonal coverage[2]
Disposition
- Admit to ICU