Mediastinitis - Causes and Signs of Mediastinitis

By the nature of the origin of the disease, there are:

• Primary - caused by injury to the organs of the mediastinum;
• Secondary - caused by the penetration of infection into the mediastinum from other areas.

According to the clinical course of the disease, there are:

• Fulminant;
• Acute;
• Chronic.

By the type of inflammation, there are mediastinitis:

• Anaerobic;
• Putrefactive;
• Serous;
• Gangrenous;
• Tuberculosis.

The chronic type of mediastinitis can be caused by aseptic or microbial causes.

Aseptic:

• Rheumatic;
• Posthemorrhagic;
• Idiopathic;
• Adiposclerotic.

Microbial:

• Specific;
• Nonspecific.

The disease is also distinguished by the type of localization.

Causes

With the primary type of the disease, mediastinitis is caused by infection from an open wound in the organs of the mediastinum, for example, with gunshot wounds. It is also possible to injure the esophagus during instrumental interventions, or when foreign bodies get in. There is a chance of getting a complication in the form of mediastinitis after a spontaneous rupture of the esophagus, with burns, perforations or the occurrence of ulcers due to tumor processes. Sometimes mediastinitis occurs after surgery due to violations of the tightness of the esophageal-gastric anastomoses, with complications after heart interventions. The secondary type of pathology is a complication in destructive and purulent processes, when inflammation passes into the mediastinal tissue, the pathogen itself can pass from other parts of the body. At the microbiological level, pathogenic organisms are usually of mixed nature.

Anaerobic:

• Prevotella;
• Petostreptococci;
• Bacteroides;
• Porphyromonas;
• Fusobacteria.

Aerobic:

• Klebsiella;
• Staphylococci;
• Streptococci.

Fungi can also act as pathogens.

Due to the mixed nature of the microflora, anaerobic and aerobic bacteria act in association, which increases the danger of the course of the disease and the threat fatal outcome.

Symptoms

The acute type of the disease demonstrates sudden development, the following symptoms appear:

• Pain behind the sternum;
• Fever (body temperature reaches 39-40 degrees);
• Chills;
• Sweating;
• Shortness of breath.

If the process is accompanied by purulent inflammation in another part of the body, manifestations of purulent intoxication occur, which ultimately leads to decreased human mobility and confusion. The most expressive symptom of mediastinitis is severe chest pain, which further increases at the moment of throwing the head back, as well as when swallowing. Therefore, patients often take forced positions, bending their heads to their chest to reduce pain. In addition, the face, upper half of the body, and neck swell, subcutaneous emphysema develops, superficial veins dilate, and cyanosis of the skin appears. Tachycardia, decreased blood pressure, and arrhythmia may occur due to intoxication. Suffocation and severe cough may be observed due to compression of the mediastinal organs. With fulminant acute mediastinitis, the patient may die within the first 2 days. Chronic aseptic mediastinitis may lead to compression of the mediastinal organs, asthmatic attacks, and hoarseness appear. Chronic microbial mediastinitis may develop if there is an encapsulated abscess in the mediastinum and the cicatricial process develops around it. Subfebrile body temperature with some fluctuations, sweating, chest pain, and weakness are also observed. If there is compression of organs, then coughing, voice changes, shortness of breath begin.

Diagnostics

In the early stages, it is quite difficult to recognize mediastinitis. The doctor must study the anamnesis in detail and carefully analyze the clinical picture. There are some objective symptoms:

• Increased pain when knocking on the sternum;
• Pain when pressing on the spinous processes of the vertebrae;
• Painful tilt of the head;
• Swelling in the jugular notch, etc.

A detailed chest X-ray, tomography, and esophagus X-ray are also required. These observations allow you to see the expansion of the shadow of the mediastinum and neck, pneumothorax, food fistulas, emphysema. If there is a suspicion of esophageal perforation, esophagoscopy is prescribed; if there is a possibility of bronchial and neck injuries, bronchoscopy is prescribed. Using ultrasound of the pleural cavity, pleural and pericardial effusion can be detected. Additionally, invasive techniques are used - diagnostic thoracoscopy, mediastinoscopy.

Treatment

First of all, antibiotics are prescribed, and drainage of foci of purulent inflammation is also performed. Urgent surgical intervention is necessary. In case of purulent and traumatic mediastinitis, mediastinal sanitation and mediastinotomy are performed. For this, active aspiration is used, the mediastinum is washed with antiseptics. In case of esophageal perforation, gastrostomy or esophagostomy is performed in parallel. If treatment is started early, 12-24 hours after the onset of the disease, defects in the walls of the bronchi and esophagus are sutured, and drainage of the pleural cavity is performed. When inflammation is caused by postoperative changes, which often happens during heart surgery, a resection of the sternum is performed, necrotic tissue is removed, and then flaps of the chest or other muscles are used for mediastinoplasty. In the case of an abscess, a transthoracic puncture is performed and the abscess area is washed. It is important to consult a surgeon before choosing a surgical technique.

Prevention

Prevention involves protecting the mediastinal organs from damage, as well as timely treatment of diseases that can lead to mediastinitis. It is advisable to immediately make an appointment with a therapist if you suspect inflammatory processes.