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Mediastinitis

Chest infection

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

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Respiratory system
Mediastinum

Causes

Mediastinitis usually results from an infection. It may occur suddenly (acute), or it may develop slowly and get worse over time (chronic). It most often occurs in person who recently had an upper endoscopy or chest surgery.

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

Other causes of mediastinitis include:

Risk factors include:

Symptoms

Symptoms may include:

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

Exams and Tests

The health care provider will perform a physical exam and ask about symptoms and medical history.

Tests may include:

The provider may insert a needle into the area of inflammation. This is to obtain a sample to send for gram stain and culture to determine the type of infection, if present.

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.

Outlook (Prognosis)

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

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

Possible Complications

Complications include the following:

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

When to Contact a Medical Professional

Contact your provider if you have had open chest surgery and develop:

If you have a lung infection or sarcoidosis and develop any of these symptoms, see your provider right away.

Prevention

To lessen the risk of developing mediastinitis related to chest surgery, surgical wounds should be kept clean and dry after surgery.

Treating tuberculosis, sarcoidosis, or other conditions associated with mediastinitis may prevent this complication.

Related Information

Acute
Chronic
Nausea and vomiting - adults
Endoscopy
Pulmonary tuberculosis
Histoplasmosis
Cancer
Sarcoidosis

References

Cheng G-S, Varghese TK, Park DR. Pneumomediastinum and mediastinitis. In: Broaddus VC, Mason RJ, Ernst JD, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 6th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 84.

Van Schooneveld TC, Rupp ME. Mediastinitis. In: Bennett JE, Dolin R, Blaser MJ, eds. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 85.

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Review Date: 10/25/2020  

Reviewed By: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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