Mediastinitis is inflammation of the mediastinum. Acute mediastinitis usually results from a perforation of the esophagus or after cardiac surgery (median sternotomy). Symptoms include severe chest pain, shortness of breath, and fever. Mediastinitis is treated with antibiotics or surgery.
What is mediastinitis?
If the mediastinum – the tissue space in which all the organs of the chest are embedded – is affected by an infection, the result is a serious and life-threatening disease. Delay in diagnosis or treatment can lead to death, with a mortality rate of 50% of those who develop the disease. See AbbreviationFinder for abbreviations related to Mediastinitis.
Streptococci, staphylococci, and Pseudomonas are pathogens that can cause mediastinitis. The purulent inflammation of the tissue spreads rapidly through the blood vessels, infecting the bloodstream and other parts of the body.
Mediastinitis causes significant scarring and interferes with the functioning of the heart and lungs. Chronic fibrosing mediastinitis narrows the tissue space and leads to long-term impairments such as thickened vascular muscles. Men of all ethnic groups between the ages of 30 and 50 belong to the highest risk category.
Causes
Mediastinitis is usually caused by an infection. It can appear suddenly (acute) or develop slowly (chronic). It occurs most commonly as a result of esophageal perforation in patients who have undergone upper endoscopy or chest surgery.
Other causes of damage to the esophagus can include severe vomiting, ingestion of toxic substances, or bruising (trauma).
Mediastinitis can also be caused by artificial respiration, infection of the teeth, gums, ears or sinuses, radiation or tuberculosis. Other risk factors include disease of the esophagus, diabetes, upper gastrointestinal problems, cancer and a weakened immune system.
Typical Symptoms & Signs
- fever and chills
- chest pain
- shortness of breath
- throat swelling
- difficulties swallowing
- confusion
Diagnosis & History
Patients affected by mediastinitis present with symptoms such as fever and chills, shortness of breath, chest pain or tightness, and a general malaise.
You are short of breath or have a sore throat. Some patients become severely ill within just a few hours, while other symptoms manifest themselves at a later stage. Diagnosis of mediastinitis is by computed tomography ( CT ) or chest x-ray and is usually obvious based on symptoms and past medical history.
It should also be considered in patients who are very ill. In order to determine the type of infection, a tissue sample can also be taken from the area of inflammation with a needle.
When should you go to the doctor?
Severe chest pain, fever and breathing problems are signs of an existing irregularity. A doctor’s visit is necessary so that treatment can take place or an existing healing plan can be optimized. Mediastinitis is common in patients who have had cardiac surgery. Another risk group includes people with a perforation of the esophagus.
If the victim suffers from acute shortness of breath, an ambulance is required. After this has been alerted, first aid must be provided. A sufficient supply of oxygen must be guaranteed so that the person concerned is not life-threatening or dies prematurely.
If you have difficulty swallowing, mental confusion or disorientation, you need a doctor. If there is shortness of breath over a longer period of time, the organism suffers from a lack of oxygen. A pale complexion, blue discolouration of the lips or a feeling of cold should therefore be presented to a doctor. If there is a tightening in the chest, abnormal heart rhythm or anxiety, a doctor should be consulted. Difficulty sleeping, feeling generally unwell, and chills are other signs of poor health. If the symptoms persist for several days or if they increase in intensity, a doctor should be consulted. Swelling in the throat area, a feeling of tightness in the throat or problems with eating should be checked out by a doctor.
Treatment & Therapy
The treatment of mediastinitis is based on the causative factors and is definitely carried out with medication under medical supervision.
In patients who are ill as a result of recent surgery, the surgical wound must be reopened and carefully cleaned and drained over several days. Necrotic or damaged tissue is removed. After the esophagus has been ruptured or ruptured, the damaged area is treated and the infected area drained.
Subsequent therapy with antibiotics such as ceftriaxone or clindamycin is usually scheduled for four to six weeks. The goal is to prevent mediastinitis from spreading to blood vessels, bones, heart, and lungs, and to avoid scarring. This is mainly caused by chronic mediastinitis. In this case, drugs that promote the breakdown of metabolic products (so-called corticoids ) are used.
This is intended to prevent the proliferation of connective tissue in the affected organs. To prevent fungal infections, antimycotics can also be added to the therapy. The treatment of chronic mediastinitis is extremely difficult and should therefore also be seen in connection with relieving treatment methods to alleviate the effects of the disease.
Outlook & Forecast
Most patients with mediastinitis have a good prognosis. Regardless of the cause, there are various treatment options that ultimately often lead to freedom from symptoms. However, if the disease progresses unfavorably, the patient may die prematurely. Drug treatment is normally used. The sufferer must take medicine for some time to allow the damaged area of the esophagus to heal completely. Under optimal conditions, freedom from symptoms is documented within a few weeks.
If there are major injuries or complications, surgery is performed. In this, damaged tissue is removed and measures are taken so that the esophagus can then resume its full function. In the further healing process, medication is also used to achieve optimal recovery. Here, too, the person concerned achieves complete freedom from symptoms within a few months.
In rare cases, chronic diseases or an additional infection occur. In addition, complications and disorders can occur during the surgical procedure. In these situations, the prognosis is significantly worse. If cancer is identified as the cause of mediastinitis, further development is linked to the prospects of healing the primary disease. In a very unfavorable case, the patient is threatened with premature death.
Prevention
The only preventive way to prevent mediastinitis as a result of an operation is the sterile treatment of the surgical wounds after an operation. Timely and successful treatment of tuberculosis, sarcoidosis, or other conditions associated with mediastinitis can avoid additional risks. This also includes the reliable healing of inflammatory processes in the head and chest area such as bronchitis or root inflammation.
Aftercare
In many cases, mediastinitis is associated with severe complications and symptoms. Therefore, the disease must be treated by a doctor in any case, so that the life expectancy of the affected person is not reduced. The affected person should therefore consult a doctor as soon as the first symptoms and symptoms of the disease appear.
Most patients suffer from the symptoms of the flu or a cold due to mediastinitis. Therefore, consistent follow-up care is required to avoid recurrence of the disease or superinfection with bacteria. Follow-up care is initiated and, if necessary, monitored by the attending physician, usually the general practitioner.
Those affected should slowly find their way back to everyday life without overexerting themselves. First and foremost, this means not putting strain on the body too early. Sport may only be practiced after consultation with the doctor in order not to expose the cardiovascular system to great stress too early.
In particular, patients with serious or chronic comorbidities, pregnant women, people with weak immune systems, the elderly and small children should follow their doctor’s aftercare instructions. Then complete resolution of mediastinitis without recurrence can be realized to a large extent. Healthy lifestyle and rest are the two factors on which follow-up care is based.
You can do that yourself
If mediastinitis has been diagnosed, medical treatment is required in any case. The doctor will treat the inflammation with antibiotics or perform surgery. You may be able to treat the individual symptoms yourself.
Difficulty swallowing can be relieved with home remedies such as warm honey or chamomile tea. Various remedies from homeopathy can be used to accompany this, such as the preparation Belladonna in the potency D12 or the preparation Arnica. Cough and shortness of breath can be reduced by inhaling salt water solutions. Appropriate measures should, however, be discussed with a doctor beforehand in order to avoid complications. Rest and bed rest are primarily indicated after an operation. The body and especially the immune system is still very weak in the first few days of the procedure and must therefore be protected.
In consultation with the doctor, various home remedies can be used to promote healing. For example, warm pads have proven their worth, as have cooling measures. In order to avoid severe scarring, the wound should be carefully cared for and regularly examined by a doctor. If complications become noticeable, a doctor’s visit is also indicated.