Synonym
Inflammation of the mediastinal space Mediastinitis occurs in both acute and chronic forms. Acute mediastinitis is a highly dangerous inflammation of the mediastinum where the heart is located. It can be caused by various pathologies such as a leak in the esophagus.
It is accompanied by a severe feeling of illness and requires quick action, otherwise it can become life-threatening. Untreated, acute mediastinitis is fatal in almost 100% of cases. Chronic mediastinitis tends to be insidious and the available therapeutic measures are limited.
Anatomy/Physiology
The mediastinum, also known as the mediastinum, is located between the left and right lungs, which are each surrounded by the pleura. At the top the mediastinum connects to the throat, at the bottom it ends at the diaphragm. The mediastinum extends from the spine to the sternum at the back.
The mediastinum is divided into an upper and a lower one. All organs of the thorax are located here, with the exception of the lungs. In addition, numerous vessels and nerves run through the mediastinum.
In the upper mediastinum, the thymus, the lower part of the windpipe (trachea), and the esophagus are located. In addition, numerous vessels run along here, including part of the aorta and part of the vena cava. Nerves, for example the 10th cranial nerve (vagus nerve), and lymphatic pathways also run through the upper mediastinum. The lower mediastinum contains the heart and the esophagus as well as numerous vessels and nerves.
Causes
The symptoms of acute mediastinitis can be very pronounced and impressive. This is also related to the fact that the symptoms of the triggering event are often initially in the foreground. For example, patients with a rupture of the esophagus often have severe chest pain, while patients with a rupture of the trachea usually suffer sudden acute shortness of breath.
Symptoms of inflammation of the mediastinum itself are usually a distinct feeling of illness with fatigue, fever, accelerated heartbeat (tachycardia) and possibly pain behind the sternum. In the chronic form, the symptoms develop rather slowly. The chronic inflammatory stimulus causes an increase in the connective tissue in the mediastinum, a process known as fibrosis.
This can lead to narrowing of the esophagus and trachea, so that patients often complain of shortness of breath (dyspnoea) or swallowing difficulties (dysphagia). It can also lead to the compression of vessels. If the upper vena cava, which carries the blood from the periphery to the heart, is compressed, this can lead to a congestion of the blood in front of the heart. If the superior vena cava is affected, this is known as an upper ventricular congestion. It can manifest itself as headache or increasing pressure in the head.
