Mediastinitis Health Article

Definition

Mediastinitis is swelling and irritation (inflammation) of the area between the lungs (mediastinum). This area contains the heart, large blood vessels, windpipe (trachea), esophagus, thymus gland, lymph nodes, and connective tissues.

Alternative Names

Chest infection

Causes, incidence, and risk factors

Mediastinitis may occur suddenly (acute) or may develop slowly and get worse over time (chronic). Most cases occur in patients who have had open chest surgery. Less than 5 percent of patients develop mediastinitis after having chest surgery.

Patients may have a tear in their esophagus that causes mediastinitis. Causes of the tear include:

• A procedure such as endoscopy
• Forceful or constant vomiting
• Trauma

Other causes of mediastinitis include:

• Cancer
• Histoplasmosis
• Radiation
• Sarcoidosis
• Tuberculosis

Risk factors include:

• Problems in the upper gastrointestinal tract
• Recent chest surgery or endoscopy
• Weak immune system

Symptoms

• Chest pain
• Chills
• Coughing up blood
• Fever
• Malaise
• Shortness of breath

Signs and tests

Signs of mediastinitis in patients who have had recent surgery include:

• Chest wall tenderness
• Wound drainage
• Unstable chest wall

Tests include:

• Chest CT scan or MRI scan
• Chest x-ray

Your health care provider may insert a needle into the area of inflammation and remove a sample to send for gram stain and culture to find the source of any infection.

Treatment

You may receive antibiotics if you have an infection.

You may need surgery to remove the area of inflammation if the blood vessels, windpipe, or esophagus is blocked.

Expectations (prognosis)

How well a person does depends on the cause of the mediastinitis.

Mediastinitis after open chest surgery is very serious. There is a significant risk of dying from the condition.

Complications

Complications include the following:

• Spread of the infection to the:
  • Bloodstream
  • Blood vessels
  • Bones
  • Heart
  • Lungs
• Scarring

Scarring can be severe, especially when it is caused by chronic mediastinitis. Scarring can interfere with heart or lung function.