Mediastinitis
Inflammation of the mediastium - ie. the cavity within the thorax between the pleural cavities.
Causes
- Direct mediastinal access
- Sternotomy / cardiothoracic surgery
- Mediastinoscopy
- Penetrating trauma
- Per trachea
- Intubation / failed percutaneous tracheostomy
- Bronchoscopy
- Per oesophagus
- Boerhaave's
- Iatrogenic oesophageal perforation
- Direct extension
- Infection from lung, pleura
Organisms: anaerobic oral flora, respiratory flora - or multi-resistant strains if cardiothoracic surgery
Features (of general inflammation)
Pyrexia
Rigors
Surgical emphysema
Hamman's sign (crunching sound in systole)
Management
- Bloods: Inflammatory markers, FBC, CRP
- Imaging: CXR (enlarged mediastinum) + CT
- Treatment: Surgical drainage/debridement + Antibiotics
