Diagnostics
If mediastinitis is suspected, the medical history and physical examination can provide important information. The patient may be asked about recent operations, and the collection of symptoms also plays an important role. For example, suddenly occurring severe chest pain after excessive vomiting can be a decisive indication of the rare Boerhaave syndrome.
Sudden shortness of breath after a bronchoscopy can be an indication of a rupture of the trachea. If chronic mediastinitis is suspected, it is important to ascertain the previous diseases. During the physical examination a skin emphysema may be palpated under certain circumstances.
This is an accumulation of air under the skin that causes a crackling sound and feeling when pressure is applied to the affected area. Such a skin emphysema can occur when air-containing organs such as the trachea or the esophagus rupture and air escapes from the organ into the mediastinum and from there towards the skin. The diagnostic measure to confirm the diagnosis is imaging of the thorax (chest). In most cases, an X-ray is taken. If this is not sufficient, it may also be necessary to produce a computed tomography (CT) image.
Therapy
The therapy of acute mediastinitis depends on the triggering event. If a hollow organ such as the esophagus or trachea is ruptured, the defect must be surgically closed as quickly as possible. Depending on the type and severity of the mediastinitis, surgical relief may be required to ensure that the pathogen-containing secretion in the mediastinum is drained.
This can be achieved by inserting a small tube (drainage), which ensures that the fluid can flow to the outside. If necessary, however, the mediastinal space must be surgically opened to allow the fluid to drain away. In any case, a high-dose intravenous (via the vein) antibiotic therapy must be administered.
The therapy of chronic mediastinitis is difficult. In case of fungal infections as a trigger, drugs that act against fungi (antimycotics) can be used. In case of mediastinitis caused by tuberculosis (consumption), drugs against the tuberculosis pathogens (tuberculostatics) can be used. Otherwise, an attempt can be made with corticosteroids, these are drugs that are able to contain the inflammatory process and the connective tissue remodelling (fibrosis) to a certain extent.
