Mediastinitis

Excerpt

Mediastinitis is inflammation or infection of the mediastinum. The mediastinum encompasses the space within the thoracic cavity, bordered by the pleural sacs laterally, the thoracic outlet superiorly, and the diaphragm inferiorly. Within the mediastinum are many vital structures: the heart, the great vessels, the trachea, mainstem bronchi, esophagus, phrenic nerve, vagus nerves, and the thoracic duct. Although mediastinitis is uncommon, it should be included in the differential diagnosis, as any infection involving the structures stated previously is considered life-threatening and requires immediate treatment.

There are multiple etiologies of mediastinitis. Three subtypes will be discussed here, including postoperative mediastinitis, descending necrotizing mediastinitis, and fibrosing mediastinitis. In the modern world, the most common of the three is postoperative mediastinitis, followed by descending necrotizing mediastinitis. These two subtypes are typically acute and follow a more fulminant time course. The least common of the subtypes, fibrosing mediastinitis, is a more chronic and indolent process.