Mediastinitis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Mediastinitis is inflammation of the tissues in the mid-chest, or mediastinum. It can be either acute or chronic.

Acute mediastinitis is usually bacterial and due to rupture of organs in the mediastinum. As the infection can progress rapidly, this is considered a serious condition. Chronic sclerosing (or fibrosing) mediastinitis, while potentially serious, is caused by a long-standing inflammation of the mediastinum, leading to growth of acellular collagen and fibrous tissue within the chest and around the central vessels and airways. It has a different cause, treatment, and prognosis than acute infectious mediastinitis.

Causes

Acute

• In modern practice, most cases of acute mediastinitis result from complications of cardiovascular or endoscopic surgical procedures.
• Odontogenic (infected tooth)
• Perforation of the esophagus (Boerhaave syndrome)
• Retropharyngeal infections

Chronic

Chronic medistinitis is usually a radiologic diagnosis manifested by diffuse fibrosis of the soft tissues of the mediastinum. This is sometimes the consequence of prior granulomatous disease, most commonly histoplasmosis. Other identifiable causes include tuberculosis and radiation therapy. Fibrosing mediastinitis most frequently causes problems by constricting blood vessels or airways in the mediastinum. This may result in such complications as superior vena cava syndrome or pulmonary edema from compression of pulmonary veins.

Treatment

Treatment for chronic fibrosing mediastinitis is somewhat controversial, and may include steroids or surgical decompression of affected vessels.