Mediastinitis

Mediastinitis is a serous or purulent inflammation of the mediastinal tissue. Occurs with inflammatory diseases or perforations of the mediastinum; Lymphadenitis with abscessing, empyema of the pleura, lung abscess with perforation in the mediastinum. In recent years, mediastinitis caused by instrumental perforations of the esophagus, trachea, and bronchi has become more frequent. Infection can get into the mediastinum and indirect way (lymphogenous) with inflammatory changes of neighboring organs: lungs, ribs, neck. The main localization of the inflammatory process is the upper mediastinum. The main etiological factors are instrumental perforations and the spread of odontogenic phlegmon of the neck to the mediastinal fiber.

Symptoms, course. The course of the disease is severe. Mediastinitis as a complication of a number of diseases is manifested by worsening of the condition with the already existing severe pathology. When there is mediastinitis against the background of odontogenic phlegmon of the neck, the patient has pain behind the sternum, high fever, chills, and tachycardia. When examining the neck marked sharply painful inflammatory infiltration, reaching the collarbone. If the phlegmon necrosis was previously performed, a significant detachable, sometimes with an unpleasant putrefactive odor, leaves the wound. When you tap the sternum, the pain intensifies. In the blood - high leukocytosis with a shift of the formula to the left. X-ray examination reveals an expansion of the shadow of the mediastinum.

With instrumental perforation of the esophagus, damage to the pear-shaped sinus occurs more often. Due to insufflation of air at the time of the study, the infection spreads rapidly through the mediastinum. Signs of intoxication appear very early and are rapidly progressing. Often immediately after the study, subcutaneous crepitus on the neck, chest pain with irradiation in the neck and interscapular space are noted. After a few hours, the temperature rises significantly, chills, profuse sweat, tachycardia, there may be clinical manifestations of septic shock. In the blood - high leukocytosis with a shift of the formula to the left. X-ray-expansion of the shadow of the mediastinum, emphysema of the mediastinum, neck. When contrasting the esophagus (only water-soluble contrast agents), you can identify the location and size of the perforation, however, when microperforating, the flow of contrast beyond the esophagus is difficult to detect.

Treatment. Produce drainage of mediastinal fat, more often by cervical access. Two-lumen drainage is removed through a separate incision, the mediastinotomic wound is sealed. After the operation, an active aspiration of the cavity and drainage to be separated is carried out. With mediastinitis on the basis of perforation of the esophagus in endoscopy, it is usually not possible to suture the defect, effectively draining the mediastinum. The patient is fed through a soft receding probe inserted into the stomach. Massive disintoxication therapy is also carried out, antibiotics of a wide spectrum of action are introduced.

With significant lesions of the thoracic esophagus accompanied by damage to the pleural leaf, short periods (less than a day) after perforation, transthoracic suturing of the defect, drainage of the mediastinum and pleural cavity are performed. After the operation, the patient is probed.

Complications: sepsis, empyema of the pleura, the development of mediastinal fibrosis is possible in the long term.

The forecast is always very serious. It depends on the nature of the underlying disease, the entrance gate of the infection, the type of pathogen.

Chronic mediastinitis is often the result of tuberculosis infection (bronchadenitis), fungal lesions, acute acute purulent mediastinitis. Clinical manifestations are caused by developing fibrosis of mediastinal fiber and progressive compressed upper vena cava, esophagus, and pulmonary veins. Patients complain of pain, fever, dyspnoea with physical exertion, a change in the voice (depressed reflex nerves). Clinical manifestations correspond to the degree of expansion of the mediastinum in the x-ray examination of the chest. Signs of compression of the superior vena cava are noted even in the absence of radiological changes.

The diagnosis is specified in angiographic and tomographic studies.

Treatment operative. During the operation, the morphological and etiological diagnosis is refined.

The prognosis is serious.