Mediastinitis: Difference between revisions
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==Background== | ==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)<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== | ||
* Chest | *[[Fever]] | ||
* Signs of [[Sepsis]] | *[[Dyspnea]] | ||
* Hamman sign on auscultation of precordium (crunch heard during systole) | *[[Chest pain]] | ||
*[[Neck pain]] and swelling | |||
**Crepitus | |||
*Signs of [[Sepsis]] | |||
*Hamman sign on auscultation of precordium (crunch heard during systole) | |||
== | ==Differential Diagnosis== | ||
== | ==Evaluation== | ||
* Septic workup to include: | *[[CXR]] - often first modality | ||
** CBC | **Typically reveals subcutaneous emphysema, widening of the mediastinum and pleural effusions | ||
** | *CT with IV contrast if diagnosis in doubt | ||
** | *Septic workup to include: | ||
** Cultures of mediastinal | **CBC | ||
**Lactic acid | |||
**Blood cultures (incl gram Stain) | |||
**Cultures of mediastinal fluid | |||
==Management== | ==Management== | ||
* ''Patients with mediastinitis require surgery'' | *Aggressive airway management | ||
* Start broad-spectrum antibiotics to include Pseudomonal coverage | *''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> | |||
==Disposition== | ==Disposition== | ||
* Admit | *Admit to ICU | ||
==See Also== | ==See Also== | ||
*[[Pneumomediastinum]] | |||
*[[Thoracic Trauma]] | |||
== | ==References== | ||
<references/> | <references/> | ||
[[Category:ID]] | |||
[[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