Mediastinitis

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