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Clinical Microbiology and Infection :... Jan 2020Mediastinitis is a rare but severe infection, defined as an inflammation of the connective tissues and structures within the mediastinum. Due to its proximity to vital... (Review)
Review
BACKGROUND
Mediastinitis is a rare but severe infection, defined as an inflammation of the connective tissues and structures within the mediastinum. Due to its proximity to vital structures, mediastinitis represents a highly morbid pathological process associated with a high risk of mortality. In most cases mediastinitis requires treatment in the intensive care unit.
OBJECTIVES
To highlight to the reader the clinical features of mediastinitis, to attempt to define each clinical scenario, to describe the responsible pathogens and finally to depict both the medical and surgical treatments.
SOURCES
We performed a literature search of the PubMed and Cochrane libraries, limited for articles published between January 2003 and December 2018, reporting on acute mediastinitis.
CONTENT
The term covers different entities of different aetiologies including deep sternal wound infection related to sternotomy; oesophageal perforation or anastomosis leakage; and finally descending necrotizing mediastinitis, often secondary to oropharyngeal abscess. The responsible pathogens and therefore subsequent management depends on the underlying aetiology. Empirical antimicrobial therapy should cover the suspected microorganisms while surgery and supportive measures should aim to reduce the inoculum of pathogens by providing adequate drainage and debridement.
IMPLICATIONS
Literature concerning mediastinitis in the intensive care unit is relatively scarce. We have collated the evidence and reviewed the different causes and treatment options of acute mediastinitis with a particular focus on microbiological epidemiology. Future research in larger cohorts is needed to better understand the treatment of this difficult disease.
Topics: Abscess; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Debridement; Drainage; Humans; Intensive Care Units; Mediastinitis; Oropharynx; Sepsis
PubMed: 31306791
DOI: 10.1016/j.cmi.2019.07.005 -
The Journal of Cardiovascular Surgery Dec 2022Superior vena cava (SVC) syndrome refers to the clinical manifestations of cerebral venous hypertension secondary to obstruction of the SVC and/or the innominate veins....
Superior vena cava (SVC) syndrome refers to the clinical manifestations of cerebral venous hypertension secondary to obstruction of the SVC and/or the innominate veins. The most common cause of SVC syndrome is malignancy like small cell lung cancer and non-Hodgkin lymphoma, but there is an increasing trend of benign etiologies secondary to thrombosis due to central lines/ pacemakers or mediastinal fibrosis. Supportive measures include head elevation, diuresis, supplemental oxygen, and steroids. Thrombolysis with or without endovenous stenting is required emergently in those with airway compromise or symptoms secondary to cerebral edema. Definitive treatment in those with malignancy is multidisciplinary; this requires radiotherapy, chemotherapy, SVC stenting, oncologic surgery and SVC bypass or reconstruction. Endovascular treatment is the primary modality for palliation in malignancy and in those with benign etiology. Surgery is reserved for those who have failed or are unsuitable for endovascular treatment. In patients with benign disease endovenous stenting and open surgery provide excellent symptom relief and are safe and effective.
Topics: Humans; Superior Vena Cava Syndrome; Vena Cava, Superior; Stents; Mediastinitis; Thrombosis
PubMed: 36469045
DOI: 10.23736/S0021-9509.22.12448-1 -
Journal of Thoracic Oncology : Official... Sep 2014Anterior mediastinal masses are relatively uncommon, include a wide variety of entities, and often pose a diagnostic challenge for clinicians. In this article, available... (Review)
Review
Anterior mediastinal masses are relatively uncommon, include a wide variety of entities, and often pose a diagnostic challenge for clinicians. In this article, available data is assembled in a clinically oriented manner to develop a structured approach to evaluation of these patients. Attention to age and gender, combined with identification of certain radiographic and clinical characteristics, allows a presumptive diagnosis to be established in most patients. This structure efficiently guides what additional workup is needed.
Topics: Humans; Magnetic Resonance Imaging; Mediastinal Neoplasms; Mediastinum; Radiography
PubMed: 25396306
DOI: 10.1097/JTO.0000000000000294 -
Journal of Cardiothoracic Surgery Nov 2017Deep sternal wound complications are uncommon after cardiac surgery. They comprise sternal dehiscence, deep sternal wound infections and mediastinitis, which will be... (Review)
Review
BACKGROUND
Deep sternal wound complications are uncommon after cardiac surgery. They comprise sternal dehiscence, deep sternal wound infections and mediastinitis, which will be treated as varying expressions of a singular pathology for reasons explained in the text.
METHODOLOGY AND REVIEW
This article reviews the definition, prevalence, risk factors, prevention, diagnosis, microbiology and management of deep sternal wound infections and mediastinitis after cardiac surgery. The role of negative pressure wound therapy and initial and delayed surgical management is discussed with special emphasis on plastic techniques with muscle and omental flaps. Recent advances in reconstructive surgery are presented.
CONCLUSIONS
Deep sternal wound complications no longer spell debilitating morbidity and high mortality. Better understanding of risk factors that predispose to deep sternal wound complications and general improvement in theatre protocols for asepsis have dramatically reduced the incidence of deep sternal wound complications. Negative pressure wound therapy and appropriately timed and staged muscle or omental flap reconstruction have transformed the outcomes once these complications occur.
Topics: Cardiac Surgical Procedures; Humans; Mediastinitis; Sternotomy; Sternum; Surgical Flaps; Surgical Wound Infection; Thoracoplasty
PubMed: 29096673
DOI: 10.1186/s13019-017-0656-7 -
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 -
Journal of Visceral Surgery Apr 2013
Topics: Humans; Laparotomy; Mediastinitis; Mediastinum; Omentum; Postoperative Complications; Surgical Flaps; Wound Closure Techniques
PubMed: 23582216
DOI: 10.1016/j.jviscsurg.2013.03.009 -
Annals of Thoracic and Cardiovascular... Jun 2022The aims of this work were the retrospective analysis of a cohort of patients with acute mediastinitis treated at the authors' worksite over a 15-year period and the...
PURPOSE
The aims of this work were the retrospective analysis of a cohort of patients with acute mediastinitis treated at the authors' worksite over a 15-year period and the identification of factors that significantly affect the outcomes of the therapy.
METHODS
During the period 2006-2020, 80 patients with acute mediastinitis were treated. Within the cohort, the following were observed: the causes and the type of acute mediastinitis, length of anamnesis, comorbidities, diagnostic methods, time from the diagnosis to surgery, types and number of surgical procedures, results of microbiological tests, complications, and outcomes of the treatment.
RESULTS
The most common type of acute mediastinitis was descending mediastinitis (48.75%). A total of 116 surgical procedures were performed. Ten patients in the cohort died (12.5%). Patients older than 60 years were at a 6.8 times higher risk of death. Patients with more than two comorbidities were at a 14.3 times higher risk of death. The presence of yeasts in the culture material increased the risk of death by 4.4 times.
CONCLUSION
Early diagnosis, removal of the cause of mediastinitis, sufficient mediastinal debridement, and multiple drainage thereof with the possibility of continual postoperative lavage are essential for the successful treatment of acute mediastinitis.
Topics: Acute Disease; Drainage; Humans; Mediastinitis; Prognosis; Retrospective Studies; Treatment Outcome
PubMed: 35264480
DOI: 10.5761/atcs.oa.21-00147 -
Medicina 2023Myelolipoma is a benign non-functional tumor. Most of them are asymptomatic and discovered incidentally, either through imaging studies or at autopsy. While it most...
Myelolipoma is a benign non-functional tumor. Most of them are asymptomatic and discovered incidentally, either through imaging studies or at autopsy. While it most commonly occurs in the adrenal gland, it has also been reported at extra-adrenal sites. We present the case of a 65-year-old woman with a primary mediastinal myelolipoma. Computer tomographic scan of the thorax showed an ovoid tumor with well-defined borders of 6.5 × 4.2 cm, located in the posterior mediastinum. A transthoracic biopsy of the lesion was made, and the microscopic observation revealed hematopoietic cells and mature adipose tissue. Although computed tomography and magnetic resonance imaging are effective in diagnosing mediastinal myelolipoma, histopathological examination is essential for the definitive diagnosis.
Topics: Female; Humans; Aged; Mediastinum; Myelolipoma; Thoracic Surgery, Video-Assisted; Radionuclide Imaging; Adrenal Gland Neoplasms
PubMed: 37379542
DOI: No ID Found -
Critical Care (London, England) Jan 2023The occurrence of mediastinitis after cardiac surgery remains a rare and severe complication associated with poor outcomes. Whereas bacterial mediastinitis have been...
OBJECTIVES
The occurrence of mediastinitis after cardiac surgery remains a rare and severe complication associated with poor outcomes. Whereas bacterial mediastinitis have been largely described, little is known about their fungal etiologies. We report incidence, characteristics and outcome of post-cardiac surgery fungal mediastinitis.
METHODS
Multicenter retrospective study among 10 intensive care units (ICU) in France and Belgium of proven cases of fungal mediastinitis after cardiac surgery (2009-2019).
RESULTS
Among 73,688 cardiac surgery procedures, 40 patients developed fungal mediastinitis. Five were supported with left ventricular assist device and five with veno-arterial extracorporeal membrane oxygenation before initial surgery. Twelve patients received prior heart transplantation. Interval between initial surgery and mediastinitis was 38 [17-61] days. Only half of the patients showed local signs of infection. Septic shock was uncommon at diagnosis (12.5%). Forty-three fungal strains were identified: Candida spp. (34 patients), Trichosporon spp. (5 patients) and Aspergillus spp. (4 patients). Hospital mortality was 58%. Survivors were younger (59 [43-65] vs. 65 [61-73] yo; p = 0.013), had lower body mass index (24 [20-26] vs. 30 [24-32] kg/m; p = 0.028) and lower Simplified Acute Physiology Score II score at ICU admission (37 [28-40] vs. 54 [34-61]; p = 0.012).
CONCLUSION
Fungal mediastinitis is a very rare complication after cardiac surgery, associated with a high mortality rate. This entity should be suspected in patients with a smoldering infectious postoperative course, especially those supported with short- or long-term invasive cardiac support devices, or following heart transplantation.
Topics: Humans; Retrospective Studies; Mediastinitis; Cardiac Surgical Procedures; Candida; Belgium
PubMed: 36609390
DOI: 10.1186/s13054-022-04277-6 -
Saudi Medical Journal Sep 2014Descending necrotizing mediastinitis (DNM) is a rare but severe life threatening complication of oropharyngeal infections. We report a young lady who had severe...
Descending necrotizing mediastinitis (DNM) is a rare but severe life threatening complication of oropharyngeal infections. We report a young lady who had severe pharyngitis complicated by anterior neck infection that descended to the mediastinum causing necrotizing mediastinitis. The course of her illness was complicated with septic shock, acute kidney injury, tracheo-esophageal fistula, and critical illness polyneuropathy. There was considerable delay in her diagnosis; however, she survived after aggressive surgical intervention, wide spectrum antibiotics, and appropriate intensive care management. Early and repeated chest imaging using computed tomography was vital for the detection and follow up of this case. There is a need to increase physicians' awareness of this condition that can complicate odontogentic or pharyngeal infection, procedures, or trauma.
Topics: Adult; Female; Humans; Mediastinitis; Young Adult
PubMed: 25228187
DOI: No ID Found