Mediastinitis is inflammation of the mediastinum. Acute mediastinitis usually results from perforation of the esophagus or after heart surgery (median sternotomy). Symptoms include severe chest pain, shortness of breath, and fever. Mediastinitis is treated with antibiotics or by surgical intervention.
What is mediastinitis?
If the mediastinum – the tissue space in which all the organs of the chest are embedded – is affected by infection, the result is a serious and life-threatening condition. Delay in diagnosis or treatment can lead to death, with a mortality rate of 50% of ill cases. Streptococci, staphylococci, and pseudomonas are pathogens that can cause mediastinitis. The purulent inflammation of the tissue spreads at high speed through the blood vessels, infecting the bloodstream and other parts of the body. Mediastinitis causes significant scarring and disrupts the functioning of the heart and lungs. Chronic fibrosing mediastinitis constricts the tissue space and leads to long-term impairments such as thickened vascular muscles. Men of all ethnic groups between 30-50 years of age are in the highest risk category.
Causes
The cause of mediastinitis is usually an infection. This may occur suddenly (acute) or develop slowly (chronic). It most commonly occurs as a result of perforation of the esophagus in patients who have undergone upper endoscopy or breast surgery. Other causes of esophageal damage may include severe vomiting, ingestion of toxic substances, or contusions (trauma). Mediastinitis can also be caused by artificial respiration; infections of the teeth, gums, ears, or sinuses; radiation; or tuberculosis Risk factors also include esophageal disease, diabetes, upper gastrointestinal tract problems, cancer, and a weakened immune system.
Typical symptoms and signs
- Fever and chills
- Chest pain
- Shortness of breath
- Throat swelling
- Difficulty swallowing
- Confusion
Diagnosis and course
Patients affected by mediastinitis show symptoms such as fever and chills, shortness of breath, pain or pulling in the chest and a general feeling of malaise. They suffer from shortness of breath or have pain in the throat. Some patients become severely ill within just a few hours and while other symptoms do not show up until a later time. Diagnosis of mediastinitis is made by computed tomography (CT) scan or chest X-ray and is usually obvious based on the symptoms as well as the present medical history. It should also be considered in patients who are very ill. In addition, to determine the nature of the infection, a tissue sample can be obtained with a needle from the area of inflammation.
When should you see a doctor?
Severe chest pain, fever, and respiratory disturbances are signs of an existing irregularity. A visit to the doctor is necessary so that treatment can be given or an existing recovery plan can be optimized. Mediastinitis often occurs in patients who have undergone heart surgery. The other risk group includes people with perforation of the esophagus. If the affected person experiences acute respiratory distress, an ambulance is needed. After this has been alerted, first aid must be administered. An adequate oxygen supply must be ensured to prevent a threat to life or premature death of the affected person. In case of difficulty in swallowing, mental confusion or disorientation, a doctor is required. If shortness of breath is present for a prolonged period of time, the organism suffers an oxygen deficiency. A pale complexion, blue discoloration of the lips or a sensation of cold should therefore be presented to a physician. If there is a pulling in the chest, abnormalities in the heart rhythm or anxiety, a doctor should be consulted. Sleep disturbances, a general feeling of malaise and chills are further signs of a health impairment. If the symptoms persist over several days or increase in intensity, a doctor should be consulted.Swelling around the throat, a feeling of tightness in the throat, or discomfort with food intake should be evaluated by a physician.
Treatment and therapy
Treatment of mediastinitis is based on the causative factors and definitely involves medication under medical supervision. Patients who have become ill as a result of recent surgery must have the surgical wound reopened and carefully cleaned and drained for several days. Necrotic or damaged tissue is removed. After suffering a tear or rupture of the esophagus, 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 aim is to prevent the 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. Treatment of chronic mediastinitis is extraordinarily difficult and should therefore also be viewed in the context of relieving treatment methods to alleviate disease-related effects.
Outlook and prognosis
Patients with mediastinitis receive a good prognosis in most cases. Regardless of the presenting cause, there are several treatment options that ultimately often induce symptom relief. Nevertheless, if the course of the disease is unfavorable, the affected person may also die prematurely. Normally, a drug treatment is applied. The affected person must take medication for some time so that the damaged area on the esophagus can heal completely. Under optimal conditions, freedom from symptoms is documented within a few weeks. If larger injuries are present or complications occur, a surgical procedure is performed. Damaged tissue is removed and measures are taken to allow the esophagus to resume its full function. Medications are also used in the further healing process to achieve optimal recovery. Here, too, the affected person achieves complete freedom from symptoms within a few months. In rare cases, chronic illness or additional infection may occur. In addition, complications and disorders may occur during the surgical procedure. In these situations, the prognosis is considerably worse. If the cause of mediastinitis is determined to be cancer, further development is tied to the prospects of cure of the primary disease. In a very unfavorable case, the patient faces premature death.
Prevention
The only preventive way to avoid mediastinitis secondary to surgery is to provide sterile care for surgical wounds after surgery. Prompt and successful treatment of tuberculosis, sarcoidosis, or other conditions associated with mediastinitis can prevent additional risks. This also includes reliable healing of inflammatory processes in the head and chest area, such as bronchitis or root inflammation.
Follow-up
Mediastinitis in many cases is associated with severe complications and discomfort. Therefore, the disease must be treated by a doctor in any case, so that there is no reduction in the life expectancy of the affected person. Therefore, the affected person should consult a doctor at the first symptoms and discomfort of the disease. Most patients suffer from the symptoms of flu or a cold as a result of mediastinitis. Therefore, consistent follow-up care is necessary to avoid a flare-up of the disease or superinfection with bacteria. Follow-up care is initiated and, if necessary, monitored by the attending physician, usually the family doctor. Affected persons should slowly return to everyday life without overexerting themselves. First and foremost, this means not putting too much strain on the body too soon. Sports should only be practiced after consultation with the doctor, so as not to subject the cardiovascular system to too much strain too soon.Especially patients with serious or chronic concomitant diseases, pregnant women, people with weak immune system, seniors and small children should follow the aftercare instructions of their doctor. Then complete remission of mediastinitis without recurrence can be realized to a great extent. The healthy lifestyle and sparing are the two factors on which the aftercare is based.
This is what you can do yourself
If mediastinitis has been diagnosed, medical treatment is definitely required. The medical professional will treat the inflammation with antibiotics or initiate surgical intervention. The individual symptoms can possibly be treated by oneself. The difficulty in swallowing can be alleviated by home remedies such as warm honey or chamomile tea. Accompanying remedies are various homeopathic remedies, such as the preparation Belladonna in the potency D12 or the preparation Arnica. Coughing and shortness of breath can be reduced by inhaling salt water solutions. However, appropriate measures should be discussed with a doctor beforehand to avoid complications. After surgery, first and foremost, rest and bed rest are indicated. The body, and in particular the immune system, is still very weakened in the first few days after the operation and must therefore be protected. In consultation with the doctor, various home remedies can be used to promote healing. Warm compresses, for example, but also cooling measures have proven effective. To avoid severe scarring, the wound should be carefully cared for and regularly examined by a doctor. If complications become apparent, a visit to the doctor is also indicated.
