Mediastinum

Mediastinitis: causes, symptoms, diagnosis and treatment

Mediastinitis is a serious disease characterized by inflammation of the mediastinal tissue. It can occur as a result of infection caused by inflammatory diseases, perforations of the mediastinal organs, lymphadenitis with abscessation, lung abscesses and other causes.

In recent years, mediastinitis caused by instrumental perforations of the esophagus, trachea, and bronchi has become more frequent. In addition, the infection can enter the mediastinum indirectly (lymphogenous) due to inflammatory changes in neighboring organs: lungs, ribs, neck. The main localization of the inflammatory process is the upper mediastinum.

Symptoms of mediastinitis depend on its cause. When mediastinitis occurs against the background of odontogenic phlegmon of the neck, the patient develops chest pain, high fever, chills, and tachycardia. With instrumental perforation of the esophagus, damage to the pyriform sinus often occurs. Due to air insufflation at the time of examination, the infection quickly spreads through the mediastinum. Signs of intoxication appear very early and progress rapidly.

If mediastinitis is detected, it is necessary to conduct a comprehensive diagnosis, including X-ray examination, angiography and tomography. When contrasting the esophagus, it is possible to identify the location and size of the perforation, but with microperforation, it is difficult to detect the flow of contrast beyond the esophagus.

Treatment of mediastinitis should be timely and comprehensive. It includes drainage of the mediastinal tissue, most often performed through a cervical approach. The double-lumen drainage is removed through a separate incision, and the mediastinotomy wound is sutured tightly. After the operation, active aspiration of the discharge is carried out with washing of the cavity and drainage.

In case of mediastinitis due to perforation of the esophagus, it is usually not possible to suture the defect during endoscopy; active drainage of the mediastinum is effective. The patient is fed parenterally and through a soft collapsible tube inserted into the stomach. Massive detoxification therapy is also carried out and broad-spectrum antibiotics are administered.

Complications of mediastinitis can be serious, including sepsis, pleural empyema, and other complications. Therefore, it is important to promptly consult a doctor if symptoms appear that may indicate mediastinitis.

In general, prevention of mediastinitis includes preventing infections that can lead to the development of the disease, as well as timely treatment of diseases that can trigger mediastinitis. It is also important to practice good oral and throat hygiene to prevent infections in this area.

If you suspect you have mediastinitis or have other medical conditions, contact your doctor for more information and advice on diagnosis and treatment.