Mediastinitis: Difference between revisions
(restructured, new info, mngt) |
No edit summary |
||
| Line 5: | Line 5: | ||
***Streptococcus and Bacteroides | ***Streptococcus and Bacteroides | ||
**Can be traumatic (swallowed razor blades, etc) | **Can be traumatic (swallowed razor blades, etc) | ||
===Etiology=== | |||
* 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)]] | |||
* [[Ludwig Angina]] | |||
* [[Thoracic Trauma]] | |||
* Lung infection extension | |||
==Clinical Features== | ==Clinical Features== | ||
*Fever | *[[Fever]] | ||
*Dyspnea | *[[Dyspnea]] | ||
*Chest pain | *[[Chest pain]] | ||
*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== | ||
==Workup== | ==Workup== | ||
Revision as of 12:58, 3 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)
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
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.