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Seminars in Diagnostic Pathology Mar 2022Acute mediastinitis is a rare infection that carries high morbidity and mortality. They are complications seen most often with deep sternal wound infections from... (Review)
Review
Acute mediastinitis is a rare infection that carries high morbidity and mortality. They are complications seen most often with deep sternal wound infections from surgeries with median sternotomies, oropharyngeal and odontogenic infections and esophageal perforations. These conditions should be promptly recognized and treated. Mediastinal granulomas are focal, mass-like lesions commonly resulting from prior granulomatous infections. They are regarded as benign, self-resolving lesions however can cause complications by compression of adjacent mediastinal structures. Chronic fibrosing mediastinitis is a rare, diffuse fibroinflammatory process most often seen with granulomatous infections and carries a worse prognosis than mediastinal granulomas especially when adjacent mediastinal structures are compromised. In this review, we discuss the epidemiology, etiology, clinical presentation, treatment and prognosis of acute mediastinitis, mediastinal granulomas, and chronic fibrosing mediastinitis.
Topics: Acute Disease; Granuloma; Humans; Mediastinitis; Mediastinum; Sclerosis
PubMed: 34176697
DOI: 10.1053/j.semdp.2021.06.008 -
Rozhledy V Chirurgii : Mesicnik... Nov 2011The authors give an outline of the issue of acute mediastinitis. It is a severe infection of connective tissue of the mediastinum. Timing of recognition and accuracy of... (Review)
Review
The authors give an outline of the issue of acute mediastinitis. It is a severe infection of connective tissue of the mediastinum. Timing of recognition and accuracy of drainage are the most essential conditions of successful treatment. Acute mediastinitis may be divided in the postoperative sternal infections with infection of the mediastinum, mediastinitis due to perforation of the aero-digestive tract and descending necrotizing mediastinitis. The authors describe etiopathogenesis, diagnostics and therapy in each particular type of mediastinitis.
Topics: Acute Disease; Humans; Mediastinitis
PubMed: 22442869
DOI: No ID Found -
Radiographics : a Review Publication of... 2001Fibrosing mediastinitis is a rare benign disorder caused by proliferation of acellular collagen and fibrous tissue within the mediastinum. Although many cases are... (Review)
Review
Fibrosing mediastinitis is a rare benign disorder caused by proliferation of acellular collagen and fibrous tissue within the mediastinum. Although many cases are idiopathic, many (and perhaps most) cases in the United States are thought to be caused by an abnormal immunologic response to Histoplasma capsulatum infection. Affected patients are typically young and present with signs and symptoms of obstruction or compression of the superior vena cava, pulmonary veins or arteries, central airways, or esophagus. There may be two types of fibrosing mediastinitis: focal and diffuse. The focal type usually manifests on computed tomographic (CT) or magnetic resonance (MR) images as a localized, calcified mass in the paratracheal or subcarinal regions of the mediastinum or in the pulmonary hila. The diffuse type manifests on CT or MR images as a diffusely infiltrating, often noncalcified mass that affects multiple mediastinal compartments. CT and MR imaging play a vital role in the diagnosis and management of fibrosing mediastinitis.
Topics: Fibrosis; Humans; Magnetic Resonance Imaging; Mediastinitis; Prognosis; Tomography, X-Ray Computed
PubMed: 11353121
DOI: 10.1148/radiographics.21.3.g01ma17737 -
The Indian Journal of Medical Research Jun 2019
Topics: Female; Humans; India; Mediastinitis; Middle Aged; Sclerosis
PubMed: 31496535
DOI: 10.4103/ijmr.IJMR_1364_17 -
Acta Chirurgica Iugoslavica 2001Mediastinitis is serious, life-threating infection. Desceding necrotizing mediastinitis is a form of mediastinitis with mortality rate of 40%. It develops as a... (Review)
Review
Mediastinitis is serious, life-threating infection. Desceding necrotizing mediastinitis is a form of mediastinitis with mortality rate of 40%. It develops as a complication of odontogenic and deep cervical infection. Early diagnosis and therapy are the most important issues. Computed tomographic scan is suggested if odontogenic infection is complicated with dyspnea. Mediastinitis is usually polymicrobial infection. Transcervical mediastinal drainage and intravenous antibiotic therapy are suggested. In some [figure: see text] cases aggressive mediastinal drainage by thoracotomy approach is performed.
Topics: Humans; Mediastinitis; Necrosis
PubMed: 11889988
DOI: No ID Found -
Zentralblatt Fur Chirurgie Oct 2015Acute infection of the mediastinum remains a condition with high morbidity and lethality rates. The manifestation and course of the illness vary widely depending on the... (Review)
Review
Acute infection of the mediastinum remains a condition with high morbidity and lethality rates. The manifestation and course of the illness vary widely depending on the cause of infection. Lack of knowledge or awareness of the illness and mostly unspecific clinical symptoms often delay diagnosis and thereby the start of adequate therapy. Computed tomography (CT) of the neck and thorax is the method of choice for diagnostics and control of therapeutic success. An early diagnosis with immediate surgical debridement and drainage of all infected tissue compartments, as well as strict sepsis therapy, are decisive for the prognosis.
Topics: Acute Disease; Algorithms; Debridement; Diagnosis, Differential; Humans; Mediastinitis; Mediastinoscopy; Necrosis; Survival Rate; Thoracic Surgery, Video-Assisted; Thoracoscopy; Thoracotomy; Tomography, X-Ray Computed
PubMed: 26351767
DOI: 10.1055/s-0035-1557779 -
Der Chirurg; Zeitschrift Fur Alle... Jun 2016A systematic approach to the etiology and possible course of acute mediastinitis is a prerequisite for adequate diagnostics and therapy. Chronic mediastinitis represents... (Review)
Review
BACKGROUND
A systematic approach to the etiology and possible course of acute mediastinitis is a prerequisite for adequate diagnostics and therapy. Chronic mediastinitis represents a rarity in the clinical practice.
MATERIAL AND METHOD
A selective literature search was carried out.
RESULTS
An acute infection of the mediastinum occurs after perforation of mediastinal structures, such as the esophagus and trachea mostly of iatrogenic origin and as descending necrotizing mediastinitis (DNM) from oropharyngeal foci. The mortality rate of esophageal injuries, irrespective of the cause is currently given as 12 %. A DNM results from an unobstructed spread along the cervicothoracic spaces and is a severe infection which manifests as a clinical picture of sepsis. The mortality rate given in the currently available literature is 14 %. Chronic mediastinitis is a very rare condition which is characterized by the proliferation of fibrous and collagenous tissue in the mediastinum. Whereas the pathogenesis remains unclear, there are indications for a Histoplasma capsulatum infection as the causal link. The prognosis is good.
CONCLUSION
After perforation of the esophagus or trachea there is always the risk of an infection of the mediastinum; therefore, the diagnosis is followed by further evaluation and early therapy. The DNM can cause unspecific symptoms of sepsis without an obvious focal point. It is important to be aware of a possible correlation between an oropharyngeal center of infection and mediastinitis in order to initiate appropriate diagnostic imaging in cases with the slightest suspicion. Chronic mediastinitis is a rare condition with varying courses and can be difficult to diagnose. An histological clarification for distinction from malignant diseases appears to be a sensible approach.
Topics: Acute Disease; Chronic Disease; Humans; Mediastinitis; Necrosis; Risk Factors; Survival Analysis; Tomography, X-Ray Computed
PubMed: 27138268
DOI: 10.1007/s00104-016-0172-7 -
The Annals of Thoracic Surgery Mar 1996Although the incidence of mediastinal wound infection in patients undergoing median sternotomy for cardiopulmonary bypass is less than 1%, its associated morbidity,... (Review)
Review
Although the incidence of mediastinal wound infection in patients undergoing median sternotomy for cardiopulmonary bypass is less than 1%, its associated morbidity, mortality, and "cost" remain unacceptably high. There is considerable lack of consensus regarding the ideal operative treatment of complicated median sternotomy wounds. The aim of this article is to review the current preventive, diagnostic, and therapeutic techniques offered to patients with mediastinitis. We also propose a new classification for postoperative mediastinitis. Data from the English-language literature suggest that the type of mediastinitis and direct assessment of the mediastinum under general anesthesia are the main determinants of the nature of subsequent operative treatment. Wound debridement and removal of foreign materials are essential steps of whatever procedures are applied. Closed mediastinal irrigation can be successful in type I mediastinitis, whereas major reconstructive operation is probably the treatment of choice for patients with mediastinitis types II to V. Refinement of the current diagnostic tools and further evaluation of the benefits of primary sternal fixation in combination with a reconstructive procedure in mediastinitis types I to III could improve the outcome of this dreaded complication.
Topics: Cardiopulmonary Bypass; Humans; Mediastinitis; Risk Factors; Surgical Wound Infection
PubMed: 8619682
DOI: 10.1016/0003-4975(95)01035-1 -
The Journal of International Medical... Aug 2021Fibrous mediastinitis is a rare progressive disease characterized by invasive proliferation of fibrous tissue in the mediastinum. This tissue proliferation leads to... (Review)
Review
Fibrous mediastinitis is a rare progressive disease characterized by invasive proliferation of fibrous tissue in the mediastinum. This tissue proliferation leads to compression of the mediastinal structures in the thoracic cavity, including the pulmonary vessels, esophagus, and trachea, causing corresponding symptoms and complications such as pulmonary hypertension. In clinical practice, the diagnosis of fibrous mediastinitis is often delayed or missed because of the rarity and variable clinical manifestations of this condition. This article presents a case of idiopathic fibrous mediastinitis that manifested as pleural effusion of unknown etiology along with a review of the relevant literature.
Topics: Humans; Hypertension, Pulmonary; Mediastinitis; Mediastinum; Pleural Effusion
PubMed: 34459275
DOI: 10.1177/03000605211040264 -
Sao Paulo Medical Journal = Revista... Sep 2006Mediastinitis is an inflammation of connective tissue that involves mediastinal structures. When the condition has an infectious origin located in the cervical or oral... (Review)
Review
CONTEXT
Mediastinitis is an inflammation of connective tissue that involves mediastinal structures. When the condition has an infectious origin located in the cervical or oral region, it is termed "descending mediastinitis" (DM).
DATA SOURCES
The subject was examined in the light of the authors' own experiences and by reviewing the literature available on the subject. The Medline, Lilacs and Cochrane databases were searched for articles, without time limits, screening for the term "descending mediastinitis". The languages used were English and Spanish.
DATA SYNTHESIS
There are three main fascial pathways by which oral or cervical infections can reach the mediastinum: pretracheal, lateropharyngeal and retropharyngeal. About 70% of DM cases occur via the retropharyngeal pathway. The mortality rate is about 50%. According to infection extent, as seen using computed tomography, DM can be classified as focal (type I) or diffuse (type II). The clinical manifestations are nonspecific and resemble other systemic infections or septic conditions. The primary treatment for DM consists of antibiotics and surgical drainage. There are several approaches to treating DM; the choice of approach depends on the DM type and the surgeon's experience. In spite of all the improvements in knowledge of the microbiology and physiopathology of the disease, controversies still exist regarding the ideal duration of antibiotic therapy and whether tracheostomy is really a necessary procedure.
CONCLUSION
Since DM is a lethal condition if not promptly treated, it must always be considered to represent an emergency situation.
Topics: Humans; Mediastinitis; Tomography, X-Ray Computed
PubMed: 17262162
DOI: 10.1590/s1516-31802006000500011