Diseases

Mediastinitis – causes, symptoms & treatment

Mediastinitis

Mediastinitis is an 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. The treatment of mediastinitis is carried out with antibiotics or by means of surgery.

What is mediastinitis?

If the mediastinum – the tissue space in which all organs of the chest are embedded – is affected by an infection, a serious and life-threatening disease develops. A delay in diagnosis or treatment can lead to death, with a mortality rate of 50% of cases.

Streptococcusstaphylococci and pseudomonas are pathogens that can cause mediastinitis. The purulent inflammation of the tissues spreads at high speed through the blood vessels, infecting the bloodstream, as well as other parts of the body.

Mediastinitis causes significant scarring and disrupts the functioning of the heart and lungs. Chronic fibrosing mediastinitis narrows the tissue space and leads in the long term to impairments such as thickened vascular muscles. Men of all ethnic groups between 30 – 50 years belong to the highest risk category.

Causes

The cause of mediastinitis is usually an infection. This can occur suddenly (acute) or develop slowly (chronic). It most often occurs as a result of perforation of the esophagus in patients who have been subjected to upper endoscopy or breast surgery.

Other causes of damage to the esophagus may include severe vomiting, ingestion of toxic substances or bruises (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 diseases, diabetes, problems in the upper gastrointestinal tract, cancer and a weakened immune system.

Typical symptoms & signs

Diagnosis & course

Patients affected by mediastinitis show symptoms such as fever and chills, shortness of breath, pain or pulling in the chest and a general malaise.

You suffer from shortness of breath or have pain in your throat. Some patients become seriously ill within just a few hours and while other symptoms do not appear until a later date. The diagnosis of mediastinitis is made using computed tomography (CT) or chest X-ray and is usually obvious based on the symptoms as well as the existing medical history.

It should also be considered in patients who are very ill. In order to determine the type of infection, a tissue sample can also be taken from the area of inflammation with a needle.

When to go to the doctor?Severe chest pain, fever and breathing disorders are signs of an existing irregularity. A visit to the doctor is necessary so that treatment can be carried out or an existing healing plan can be optimized. Mediastinitis often occurs in patients who have undergone heart surgery. Another risk group includes people with a perforation of the esophagus.

If the person concerned suffers acute shortness of breath, an ambulance service is needed. After this has been alerted, first aid must be provided. An adequate supply of oxygen must be ensured so that no threat to life or premature death of the person concerned occurs.

In case of difficulty swallowing, mental confusion or disorientation, a doctor is needed. If there is shortness of breath over a longer period of time, the organism suffers a lack of oxygen. A pale complexion, blue discoloration of the lips or a feeling of cold should therefore be presented to a doctor. If there is a pulling in the chest, abnormalities of the heart rhythm or anxiety, a doctor should be consulted. Sleep disorders, a general malaise and chills are further signs of a health impairment. If the symptoms persist for several days or increase in intensity, consult a doctor. Swelling in the neck area, a feeling of tightness in the throat or discomfort with food intake should be clarified by a doctor.

Treatment & Therapy

The treatment of mediastinitis is based on the causative factors and is definitely carried out with medication under medical supervision.

Patients who have fallen ill as a result of recent surgery must have their surgical wound reopened and carefully cleaned and drained over several days. Necrotic or damaged tissue is removed. After suffering a rupture or rupture of the , the damaged area is treated and the infected area is drained.

Subsequent therapy with antibiotics such as ceftriaxone or clindamycin is usually scheduled for four to six weeks. The aim is to prevent the spread of mediastinitis to blood vessels, bones, heart and lungs and to prevent scarring. This is mainly caused by chronic mediastinitis. In this case, drugs (so-called corticoids) that promote the degradation of metabolic products are used.

This is intended to prevent the proliferation of connective tissue in the affected organs. In order to prevent fungal infections, can also be used for therapy. The treatment of chronic mediastinitis is extremely difficult and should therefore also be seen in connection with relieving treatment methods to alleviate disease-related effects.

Outlook & Forecast

Patients with mediastinitis in most cases receive a good prognosis. Regardless of the present cause, there are various treatment options, which ultimately often trigger freedom from symptoms. Nevertheless, an unfavorable course of the disease can also lead to a premature death of the person concerned. Normally, drug treatment is used. 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 there are major injuries or complications, surgery is performed. In this case, damaged tissue is removed and measures are taken so that the esophagus can then resume its full functional activity. In the further healing process, medication is also used to achieve optimal recovery. Here, too, the person concerned obtains complete freedom from symptoms within a few months.

In rare cases, chronic diseases or additional infection occur. In addition, complications and disorders may occur during the surgical procedure. In these situations, the prognosis is significantly worse. If cancer is determined to be the cause of mediastinitis, further development is linked to the healing prospects of the primary disease. In a very unfavorable case, the patient is threatened with premature death.

Prevention

The only preventive way to prevent mediastinitis as a result of surgery is the sterile treatment of surgical wounds after surgery. Timely and successful treatment of tuberculosis, sarcoidosis or other conditions associated with mediastinitis can avoid additional risks. This also includes the reliable healing of inflammatory processes in the head and chest area such as bronchitis or root inflammation.

Aftercare

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 person concerned. The person concerned should therefore consult a doctor at the first symptoms and complaints of the disease.

Most patients suffer from mediastinitis from the symptoms of flu or a cold. Therefore, consistent follow-up is required to avoid a renewed flare-up of the disease or superinfection with bacteria. Follow-up care is initiated by the attending physician, usually the family doctor, and monitored if necessary.

Those affected should slowly find their way back to everyday life without overexerting themselves. First and foremost, this includes not burdening the body too early. Sport should only be practiced after consultation with the doctor, so as not to expose the cardiovascular system to great stress too early.

Especially patients with serious or chronic comorbidities, pregnant women, people with weak immune systems, seniors and small children should follow the follow-up instructions of their doctor. Then complete resolution of mediastinitis without relapses can be realized to a large extent. The healthy lifestyle and protection are the two factors on which the aftercare is based.

What you can do yourself

If mediastinitis has been detected, medical treatment is required in any case. The physician will treat the inflammation with antibiotics or initiate surgery. The individual symptoms may be self-treated.

Difficulty swallowing can be relieved with home remedies such as warm honey or chamomile tea. Various remedies from homeopathy can be used to accompany this, such as the preparation Belladonna in the potency D12 or the preparation Arnica . Cough and shortness of breath can be reduced by inhaling salt water solutions. Appropriate measures should, however, be discussed with a doctor beforehand in order to avoid complications. Rest and bed rest are primarily indicated after an operation. The body and especially the immune system is still very weak in the first few days of the procedure and must therefore be protected.

In consultation with the doctor, various home remedies can be used to promote healing. For example, warm pads have proven their worth, as have cooling measures. In order to avoid severe scarring, the wound should be carefully cared for and regularly examined by a doctor. If complications become noticeable, a doctor’s visit is also indicated.

Lisa Newlon
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Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.