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39 - Mediastinitis

from Part VI - Clinical Syndromes – Heart and Blood Vessels

Published online by Cambridge University Press:  05 March 2013

Keith S. Kaye
Affiliation:
Duke University School of Medicine
Ravi Karra
Affiliation:
Harvard Medical School Department of Medicine
David Schlossberg
Affiliation:
Temple University School of Medicine, Philadelphia
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Summary

The mediastinum is defined as the space in the thorax between the lungs; it houses the heart, great vessels, esophagus, trachea, thymus, and lymph nodes. The connective tissues of the mediastinum are continuous with the long fascial planes of the head and neck, one reason why until the advent of thoracic surgery, mediastinitis was primarily a complication of odontogenic infections. By virtue of its deep position within the thorax, the mediastinum is a relatively protected organ space. There are four major portals of entry into the mediastinum: (1) direct inoculation of the mediastinum following sternotomy (ie, postoperative mediastinitis (POM)); (2) spread along the long fascial planes of the neck (ie, descending mediastinitis); (3) rupture of mediastinal structures, such as the esophagus; and (4) contiguous spread of infection from adjacent thoracic structures.

POSTOPERATIVE MEDIASTINITIS

Postoperative mediastinitis (POM) is classified as an organ space infection by Centers for Disease Control and Prevention (CDC) criteria and is a dreaded complication of median sternotomy. POM classically presents as a febrile illness with sternal wound dehiscence and purulent drainage, usually 2 to 4 weeks after sternotomy. Occasionally POM presents as a more chronic, indolent infection months to years after sternotomy. Sometimes, only superficial signs of infection are present, making POM difficult to diagnose. Frequently, a high index of clinical suspicion is required to differentiate POM from a more superficial sternal wound infection.

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Publisher: Cambridge University Press
Print publication year: 2008

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  • Mediastinitis
  • Edited by David Schlossberg
  • Book: Clinical Infectious Disease
  • Online publication: 05 March 2013
  • Chapter DOI: https://doi.org/10.1017/CBO9780511722240.040
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  • Mediastinitis
  • Edited by David Schlossberg
  • Book: Clinical Infectious Disease
  • Online publication: 05 March 2013
  • Chapter DOI: https://doi.org/10.1017/CBO9780511722240.040
Available formats
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To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Mediastinitis
  • Edited by David Schlossberg
  • Book: Clinical Infectious Disease
  • Online publication: 05 March 2013
  • Chapter DOI: https://doi.org/10.1017/CBO9780511722240.040
Available formats
×