Mediastinitis

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Background

  • A serious infection of the mediastinum with significant morbidity and mortality and generally requires surgery

Clinical Features

  • Chest Pain
  • Signs of Sepsis
  • Hamman sign on auscultation of precordium (crunch heard during systole)

Etiology

  • Prior cardiovascular surgery (most common cause)
  • Esophageal rupture (Boerhaave Syndrome)
  • Ludwig Angina
  • Trauma
  • Lung infection extension

Workup

  • Septic workup to include:
    • CBC
    • Blood cultures
    • Gram Stain
    • Cultures of mediastinal pacing wires
  • CT if diagnosis in doubt

Management

  • Patients with mediastinitis require surgery
  • Start broad-spectrum antibiotics to include Pseudomonal coverage

Disposition

  • Admit

See Also

Sources

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