A health condition that causes inflammation in the mediastinum (the part of the chest between the lungs that contains the heart and other organs) is called mediastinitis. This disease can be acute (sudden) or chronic (long-term). Typically, acute mediastinitis occurs due to complications from a median sternotomy or an esophageal tear. While people often experience fever, chest pain, and problems with breathing, they may also experience other symptoms. The only way to prevent serious complications and improve your chances of survival is early detection and treatment.
In rare cases, mediastinitis may be caused by fungal infections, certain medical conditions (such as tuberculosis), or extension from oral or neck infection. In general, the mediastinum is located in the middle compartment of the thoracic cavity. However, this cavity also includes two pleural cavities, which sit on each side of the mediastinum and house the lungs. In addition, the mediastinum also contains the heart, esophagus, major blood vessels, lymph nodes, and nerves. The anatomy of the mediastinum helps us understand how serious mediastinitis can be.
How Common is Mediastinitis?
While doctors consider this condition rare, its prevalence (the number of people within a certain population who have this disease) is based on the form (acute or chronic).
Acute Mediastinitis
Usually, people develop this form of mediastinitis as a complication of chest surgeries (such as a median sternotomy). During this procedure, surgeons separate the sternum (breastbone) to access the heart or nearby blood vessels. About 5% to 25% of people who receive a median sternotomy will develop mediastinitis.
Chronic Mediastinitis
This form of the disease occurs rarely, and it is often diagnosed in regions where a type of fungal infection (Histoplasma capsulatum) is common. In any case, not everyone who is exposed to this type of fungi will develop mediastinitis. According to some research, less than 1% of people who were exposed to Histoplasma capsulatum develop a fungal infection. Nowadays, there are several hundred people in the U.S. with fibrosing mediastinitis.
Symptoms
The symptoms often appear differently among people with this disease because they depend on several factors. These include the form of mediastinitis, gender, age, and overall health. Check some examples below:
Acute Mediastinitis Symptoms
Chronic Mediastinitis Symptoms
Sometimes, people with this form of the disease may not experience any symptoms. However, those who develop fibrosing mediastinitis may notice the following symptoms. Examples include:
- Chest pain
- Cough (sometimes, with blood)
- Symptoms associated with superior vena cava syndrome
- Breathing problems
If you experience any of the previous symptoms, immediately contact your healthcare professional. Otherwise, it may lead to life-threatening complications.
Causes
The acute form of mediastinitis often occurs when the tissues inside the chest suddenly become infected. Check some causes below:
- Complications from a median sternotomy – The most common cause of post-surgery infections is a bacterium called Staphylococcus aureus. Usually, this bacterium enters the body through the surgical wound.
- Esophageal perforation – This is a tear of the esophagus, which may occur due to multiple reasons. For example, complications from endoscopic procedures, Boerhaave syndrome (forceful vomiting), and other conditions.
- Infections that spread from the head or neck – In such cases, the condition is called descending necrotizing mediastinitis, and it often occurs due to an infection that spreads to the chest from another infection (such as an abscessed tooth).
However, the chronic form of mediastinitis often occurs due to an infection, but the tissues develop inflammation more slowly. Check below some causes of chronic mediastinitis:
- Scilicosis
- Sarcoidosis
- Radiation therapy (a cancer treatment)
- Tuberculosis
- Fungal infections (this is one of the most common causes of chronic mediastinitis)
In some cases, doctors cannot identify the exact cause of the chronic form of this disease. Thus, it is called idiopathic chronic mediastinitis. Furthermore, the fungus that causes fungal infections (the most common cause of chronic mediastinitis) lives in soil and often is harmless unless it becomes airborne.
Risk Factors
Healthcare professionals have identified some factors that may elevate your risk of developing mediastinitis. For example:
- Diseases that suppress your immune system (such as cancer, HIV infection, and others)
- Chronic obstructive pulmonary disease (COPD)
- Diabetes
- Kidney failure
- Obesity (excessive body weight)
- Peripheral artery disease (PAD)
- Smoking – Tobacco products increase the risk of post-surgery complications.
- Recent median sternotomy
There are other factors related to the surgery that may also increase the risk of mediastinitis. For example, multiple surgeries in a short period of time or spending a long time in surgery or connected to cardiopulmonary bypass.
Complications
This condition can be life-threatening because the inflammation it causes may negatively affect the normal functioning of multiple organs and blood vessels in the mediastinum. The only sure way to prevent the following complications is early diagnosis and treatment. Check some complications below:
- Constrictive pericarditis
- Recurrent pneumonia
- Right-sided heart failure
- Sepsis
- Severe bleeding
- Blocked airway
- Superior vena cava syndrome
- Organ failure
- Death
This article does not contain a complete list of mediastinitis complications.
How to Prevent Mediastinitis?
Most of the time, mediastinitis is a complication of certain surgical procedures. Thus, you can talk with your doctor about ways to reduce the risk of developing it. However, preventing infections may help reduce the risk of acute mediastinitis. Check some tips below:
- Oral hygiene – It is recommended to take good care of your teeth and gums. It helps prevent dental infections that eventually may spread to the mediastinum.
- Dental examinations – Normally, you should visit a dentist every 6 months for a cleaning.
- Annual checkups with your healthcare provider to monitor your overall health.
Diagnosis
In most cases, the diagnosis of mediastinitis begins with a physical examination in which doctors will check for abnormalities linked to the disease. Thereafter, they may also ask some questions about your symptoms, travel history, medical history, and recent surgeries. In any case, to confirm or rule out mediastinitis, doctors will perform the following tests. For example:
- Contrast-enhanced computed tomography (CT) scans – These tests are considered the gold standard for diagnosing mediastinitis.
- Chest X-rays – This is another imaging test used to examine the inside of the thoracic cavity. Moreover, this test often helps identify mediastinal tumors.
- Needle biopsy – During this test, doctors will use a needle to get a sample of the affected tissue for testing.
Treatment
Doctors often prescribe different treatments for people who develop mediastinitis. It depends on the form of the condition (acute or chronic), age, the underlying cause, and preferences. They often prescribe antibiotics and surgery to remove dead tissue and drain fluid if the acute form of the condition is a complication of a median sternotomy. Moreover, some people with acute mediastinitis may also receive treatment in an intensive care unit (ICU).
Usually, treatments for people with chronic mediastinitis include surgery to ease the symptoms and procedures to open up the airways or improve blood flow through blood vessels in the mediastinum.
Frequently Asked Questions
When should I see my healthcare provider?
While the acute form of mediastinitis requires immediate treatment because it occurs suddenly, the chronic form develops slowly.
What is the difference between acute and chronic mediastinitis?
The acute form of this condition is life-threatening because it causes sudden and severe symptoms. Moreover, when it is caused by a tear in the esophagus, the infection develops within several hours. Without immediate treatment, acute mediastinitis may lead to death. However, the chronic form is also a serious health condition, but it often develops slowly (over several months or years). Moreover, this form of mediastinitis may lead to a buildup of scar tissue in the mediastinum (fibrous mediastinitis). In most cases, people develop chronic mediastinitis due to a fungal infection.
Is mediastinitis fatal?
This is a life-threatening condition that can be fatal, especially without treatment. The only way to improve the survival chances is early diagnosis and proper treatment. Check below some information about mediastinitis mortality rate:
- The mortality rate for people who have acute mediastinitis after a median sternotomy ranges from 1% to 14%.
- However, if you develop the acute form of mediastinitis due to an esophageal tear, the mortality rate ranges from 30% to 40% for people who do not get treatment in the first 24 hours. With treatment, the mortality rate drops to 10% in the first 24 hours.
- The mortality rate in people who develop descending necrotizing mediastinitis ranges from 11% to 40%. In such cases, people may quickly develop sepsis and organ failure.
If you have any other questions, ask your healthcare provider.
