Mediastinitis: Difference between revisions
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==Background== | ==Background== | ||
* | * Inflammation of the mediastinum | ||
**Commonly caused by esophageal rupture or perforation | |||
**Typically caused by infection | |||
***Streptococcus and Bacteroides | |||
**Can be traumatic (swallowed razor blades, etc) | |||
==Clinical Features== | ==Clinical Features== | ||
* | *Fever | ||
*Dyspnea | |||
*Chest pain | |||
*Neck pain and swelling | |||
**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) | ||
==Etiology== | ==Etiology== | ||
* Prior cardiovascular surgery (most common cause) | * 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]] | ||
| Line 21: | Line 28: | ||
** Gram Stain | ** Gram Stain | ||
** Cultures of mediastinal pacing wires | ** Cultures of mediastinal pacing wires | ||
*CXR - often first modality | |||
**Typically reveals subcutaneous emphysema, widening of the mediastinum and pleural effusions | |||
* CT if diagnosis in doubt | * CT if diagnosis in doubt | ||
==Management== | ==Management== | ||
*Airway intact? | |||
* ''Patients with mediastinitis emergently require surgery'' | * ''Patients with mediastinitis emergently require surgery'' | ||
**Consult | |||
***CT Surgery for repair | |||
***ENT if upper neck area | |||
***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 | ||
==See Also== | ==See Also== | ||
*[[Pneumomediastinum]] | *[[Pneumomediastinum]] | ||
Revision as of 15:54, 2 February 2015
Background
- Inflammation of the mediastinum
- Commonly caused by esophageal rupture or perforation
- Typically caused by infection
- Streptococcus and Bacteroides
- Can be traumatic (swallowed razor blades, etc)
Clinical Features
- Fever
- Dyspnea
- Chest pain
- Neck pain and swelling
- Crepitus
- Signs of Sepsis
- Hamman sign on auscultation of precordium (crunch heard during systole)
Etiology
- Prior cardiovascular surgery (most common cause)[1]
- Esophageal rupture (Boerhaave Syndrome)
- Ludwig Angina
- Thoracic Trauma
- Lung infection extension
Workup
- Septic workup to include:
- CBC
- Blood cultures
- Gram Stain
- Cultures of mediastinal pacing wires
- CXR - often first modality
- Typically reveals subcutaneous emphysema, widening of the mediastinum and pleural effusions
- CT if diagnosis in doubt
Management
- Airway intact?
- 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
See Also
Sources
Medscape: Mediastinitis Treatment & Managemen. Mueller DK, et al.