What is Mediastinitis?

Mediastinitis in an infection of the mediastinum, which is the area between the lungs that contains the heart, windpipe, esophagus, larynx and connective tissues. It is a serious and life-threatening condition. A delay in diagnosis or treatment can cause death.

This condition often occurs because of a perforation or tear in the esophagus. Esophageal ruptures can happen during medical procedures such as bronchoscopy or endoscopy or as the result of constant or violent vomiting. Patients might suffer ruptures after receiving a traumatic injury to the neck or chest. Other causes include drinking lye, swallowing button-shaped batteries or taking certain pills.

Mediastinitis also can occur after heart surgery. Patients who have cancer, sarcoidosis or tuberculosis are at high risk of developing the condition. Other risk factors — such as upper gastrointestinal infections, a weakened immune system and infections of the teeth, gums, ears or sinuses — can contribute to mediastinitis. Males of all ethnicities who are 30-50 years old are in the highest-risk category.

Affected patients demonstrate symptoms such as fever and chills, shortness of breath, chest pain or tenderness and a general feeling of ill health. Patients might also feel confused or have pain in the throat. Some patients become seriously ill within only a few hours, and others experience symptoms for several days before seeking medical attention.

The streptococcus, staphylococcus and pseudomonas pathogens, among many others, cause mediastinitis. The disease can spread rapidly through the blood vessels and infect the bloodstream as well as other parts of the body. It causes significant scarring that interferes with the ability of the heart and lungs to function normally.

Doctors usually can diagnose mediastinitis fairly easily, given the patient's medical history. The physician inserts a needle at the infected site to collect a culture and find out what kind of infection the patient has. He or she confirms the findings through X-rays, magnetic resonance imaging (MRI) or computed tomography (CT) scans.

Patients who develop mediastinitis after recently undergoing chest surgery must have the surgical wound re-opened and drained. The doctor will remove the necrotic or damaged tissues and place the patient on antibiotics. Patients who develop mediastinitis after suffering a tear or rupture to the esophagus will need to have the damaged area repaired and the infected area drained. The doctor will prescribe antibiotics such as ceftriaxone and clindamycin to clear up the infection. Patients usually require four to six weeks of antibiotic therapy.