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Acute Mediastinitis


Presentation

  • In each case, treatment should be individualized to the clinical presentation and suspected cause.[ncbi.nlm.nih.gov]
  • In this report, we present the case of a 50-year-old female suffering from acute mediastinitis with pleural effusion arising from recurrent pancreatitis that improved after surgical intervention.[ncbi.nlm.nih.gov]
  • While DNM is seen infrequently, its severe nature makes it essential that emergency physicians consider the diagnosis in patients presenting with upper respiratory infections, chest pain, and systemic symptoms, and also in patients with a recent diagnosis[ncbi.nlm.nih.gov]
  • Two cases of acute mediastinitis after replacement of the ascending aorta are presented. Both were treated by debridment and immediate closure with placement of multiple Redon suction tubes (Lecompte's method) associated with a primary omentoplasty.[ncbi.nlm.nih.gov]
  • The goal of this study was to determine the incidence of acute mediastinitis as an early postoperative complication related to this procedure and to present outcomes of non-surgical conservative management in this complication.[ncbi.nlm.nih.gov]
Fever
  • A 24-year-old woman was admitted to our hospital for complaints of chest pain and fever and was subsequently diagnosed as having an anterior mediastinal tumor.[ncbi.nlm.nih.gov]
  • Fevers with tachycardia and elevation of inflammatory markers usually indicate an infectious etiology that should be worked up.[journals.lww.com]
  • Early signs and symptoms include fever, severe pain and swelling, and redness at the wound site. Moreover, fulminant evolution and high mortality rate are typical of this pathology.[roderic.uv.es]
  • We have described a case of acute necrotising mediastinitis in a young woman who was referred to our attention owing to a swelling in the oral floor, fever, trismus and pharyngodynia that had appeared about 10 days earlier after a tooth abscess that did[minervamedica.it]
  • Acute mediastinitis is often associated with chills, fever, or shock. If pleural extension develops, breathing may aggravate the pain or cause radiation to the shoulder. Swallowing increases the pain, and dysphagia may be present.[for-surgeons.com]
Patient Appears Acutely Ill
  • On physical examination, the patient appeared acutely ill with a clear mental status.[wjgnet.com]
Infectious Mononucleosis
  • Infectious mononucleosis is another rare cause of DNM. The mortality of acute mediastinitis is high, while the mortality for DNM is even higher. Major determinants of mortality are delayed diagnosis and/or treatment.[ncbi.nlm.nih.gov]
Painful Cough
  • Most of the pancreaticopleural fistula patients are admitted to the hospital with respiratory symptoms since common complaints include dyspnea, chest pain, cough, sputum and fever[ 7 ].[wjgnet.com]
Mediastinal Disease
  • Mid or Lower Retrosternal Pain in mediastinal disease Character resembling cardiac pain, radiate to neck and arms, unrelated to exertion.[notes.medicosnotes.com]
Odynophagia
  • Severe odynophagia and respiratory distress with positive neck or chest findings should raise suspicion of mediastinitis. We report a rare case of acute mediastinitis secondary to the unexpected migration of an impacted fish bone from the esophagus.[ncbi.nlm.nih.gov]
  • Patients may also present with odynophagia, dyspnea, tachypnea, cyanosis, tachycardia, fever, and hypotension which may develop within hours of the perforation.[journals.lww.com]
Odynophagia
  • Severe odynophagia and respiratory distress with positive neck or chest findings should raise suspicion of mediastinitis. We report a rare case of acute mediastinitis secondary to the unexpected migration of an impacted fish bone from the esophagus.[ncbi.nlm.nih.gov]
  • Patients may also present with odynophagia, dyspnea, tachypnea, cyanosis, tachycardia, fever, and hypotension which may develop within hours of the perforation.[journals.lww.com]
Chest Pain
  • A 24-year-old woman was admitted to our hospital for complaints of chest pain and fever and was subsequently diagnosed as having an anterior mediastinal tumor.[ncbi.nlm.nih.gov]
  • While DNM is seen infrequently, its severe nature makes it essential that emergency physicians consider the diagnosis in patients presenting with upper respiratory infections, chest pain, and systemic symptoms, and also in patients with a recent diagnosis[ncbi.nlm.nih.gov]
  • Without ignoring possible cardiac or pulmonary etiologies, it is important to remember that any structure in the chest can result in “chest pain.” Esophageal etiologies of chest pain are commonly ignored.[journals.lww.com]
  • Clinical Chest pain, dysphagia, respiratory distress, cervical-upper thoracic subcutaneous crepitus. Imaging By chest X-ray (CXR); may be normal early, followed by evidence of mediastinal and subcutaneous air.[medical-dictionary.thefreedictionary.com]
  • Other common complaints were chest pain and cough in 30% and 22% of patients, respectively[ 16 ].[wjgnet.com]
Retrosternal Chest Pain
  • Retrosternal chest pain causes are given below Ischaemic heart disease. Oesophagitis or diffuse oesophageal spasm. Acute dry percardltis. Acute mediastinitis. Diaphragmatic hernia. Aneurysm of the aorta. Dissecting aneurysm. Psychogenic.[notes.medicosnotes.com]

Workup

  • In such a situation the patients should be qualified earlier for broadened diagnostic workup and for reoperation.[ncbi.nlm.nih.gov]
  • Laboratory workup revealed leukocytosis of 14,640/μL with a predominance of neutrophils (82.4%). Electrocardiogram, chest radiograph, and serum Troponin T were normal.[journals.lww.com]

Treatment

  • CONCLUSIONS: Delay in initiating treatment and intrathoracic esophageal foreign bodies are the main risk factors of mediastinitis secondary to foreign body ingestion. Computed tomography plays an important role in diagnosis and guiding treatments.[ncbi.nlm.nih.gov]
  • Abstract Acute mediastinitis is a serious disease that requires prompt diagnosis and aggressive treatment. In each case, treatment should be individualized to the clinical presentation and suspected cause.[ncbi.nlm.nih.gov]
  • Early diagnosis with prompt and aggressive treatment is essential to prevent its rapid progression. Severe odynophagia and respiratory distress with positive neck or chest findings should raise suspicion of mediastinitis.[ncbi.nlm.nih.gov]
  • Major determinants of mortality are delayed diagnosis and/or treatment.[ncbi.nlm.nih.gov]
  • […] in reaching a full diagnosis and treatment. 10 Diagnosing acute mediastinitis through conventional x-rays alone may delay treatment, and if mediastinitis is suspected based on clinical signs, computed axial tomography should be performed.[archbronconeumol.org]

Prognosis

  • This study was a retrospective evaluation of selected biochemical parameters with negative impact on the prognosis in surgically treated patients.[ncbi.nlm.nih.gov]
  • The prognosis was not related to age, gender or the kind of the pathogen. The risk of death increased depending on the number of preoperative co-morbidities (P 0.0446), particularly on the occurrence of a neoplasm (P 0.0104).[ncbi.nlm.nih.gov]
  • The occurrence of these complications darkens the prognosis of this affection usually benign.[panafrican-med-journal.com]
  • […] ascending aorta pulmonary trunk nerves cardiac plexus phrenic nerves other structures heart anterior mediastinum contains no major structures posterior mediastinum vessels descending aorta azygous venous system other structures esophagus thoracic duct Prognosis[medbullets.com]
  • Prognosis Patients with mediastinitis, empyema and purulent pericaditis should be treated with broad spectrum antibiotics, supportive care and surgical drainage. The prognosis depends on the timeliness of surgical intervention and treatment.[clinicaladvisor.com]

Etiology

  • MATERIAL/METHODS: There were 44 consecutive patients treated surgically due to AM of differentiated etiology.[ncbi.nlm.nih.gov]
  • Mediastinitis Acute mediastinitis A fulminant infectious process with a high M&M, in which organisms rapidly spread through areolar planes of mediastinum Etiology Traumatic esophageal perforation, foreign bodies, suture line leakage, post-emetic rupture[medical-dictionary.thefreedictionary.com]
  • Without ignoring possible cardiac or pulmonary etiologies, it is important to remember that any structure in the chest can result in “chest pain.” Esophageal etiologies of chest pain are commonly ignored.[journals.lww.com]
  • Thoracentesis and body fluid analysis are important in evaluating the etiology of this condition[ 3 , 5 , 7 , 8 ].[wjgnet.com]
  • It is thought to be due to four different etiologies: Mediastinitis at the US National Library of Medicine Medical Subject Headings (MeSH)[en.wikipedia.org]

Epidemiology

  • Neurology and Neurosurgery Czech and Slovak Ophthalmology Czech and Slovak Psychiatry Czech Geriatric Review Czech Gynaecology Czech Rheumatology Czech Dental Journal Czech Urology Czech-Slovak Dermatology Czecho-Slovak Pathology Czech-Slovak Pediatrics Epidemiology[prolekare.cz]
  • ., granulomatous disease) Epidemiology incidence 3% incidence of acute mediastinitis following sternotomy very low incidence of chronic mediastinitis risk factors recent sternotomy Pathophysiology mechanism of injury acute contamination from esophageal[medbullets.com]
  • Epidemiology Approximately 60,000 patients develop pleural infections in the United States each year. Between 40-60% of pneumonias will be associated with parapneumonic effusions.[clinicaladvisor.com]
Sex distribution
Age distribution

Pathophysiology

  • To discuss the pathophysiology of this disease, the authors reported the details of esophageal perforations experienced in our institute and reviewed the literature.[jstage.jst.go.jp]
  • We postulated that the pathophysiology of this mediastinitis was similar to pleural and peritoneal fistula.[wjgnet.com]
  • ., granulomatous disease) Epidemiology incidence 3% incidence of acute mediastinitis following sternotomy very low incidence of chronic mediastinitis risk factors recent sternotomy Pathophysiology mechanism of injury acute contamination from esophageal[medbullets.com]
  • Pathophysiology Empyema The potential space between the parietal pleura and visceral pleura normally contains small amounts of circulating, sterile fluid that can become infected by an adjacent pneumonia or bronchopleural fistula, or seeded by bacteremia[clinicaladvisor.com]

Prevention

  • Early diagnosis with prompt and aggressive treatment is essential to prevent its rapid progression. Severe odynophagia and respiratory distress with positive neck or chest findings should raise suspicion of mediastinitis.[ncbi.nlm.nih.gov]
  • Intravenous antibiotics are a crucial part of this treatment to help prevent / and treat possible sepsis.[thoracics.org]
  • Jarvis Guideline for prevention of surgical site infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee Am J Infect Control, 27 (1999), pp. 97-132 [7.] D. Lepelletier, S. Perron, P.[archbronconeumol.org]
  • This approach can prevent the need for a sternotomy or thoracotomy in spite of concomitant pulmonary involvement. Emergency physicians need to be familiar with this rare but lethal disease.[mrmjournal.biomedcentral.com]
  • Treating tuberculosis, sarcoidosis, or other conditions associated with mediastinitis may prevent this complication. Cheng GS, Varghese TK, Park DR. Pneumomediastinum and mediastinitis. In: Broaddus VC, Mason RJ, Ernst JD, et al, eds.[medlineplus.gov]

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