Mediastinitis Definition, Reason, Symptoms, Treatment & Prevention
Understanding
Mediastinitis is inflammation of the mediastinum part of the body, which is mainly caused by infection. The mediastinum is part of the thoracic cavity, which contains the heart, thymus gland, several lymph nodes, and parts of the esophagus, thyroid, aorta, and parathyroid glands.
This condition is actually a condition that is rarely found in those who have not undergone cardiothoracic surgery or other interventions. In people who undergo cardiothoracic surgery, the incidence of mediastinitis is only about 1 percent (based on a study of 10,000 patients). However, those who have had a heart transplant have a higher risk.
Symptom
Complaints can be felt by sufferers several days before finally coming to consult. It is possible to find a history of cardiothoracic surgery, upper gastrointestinal endoscopy, bronchoscopy, dental or oropharyngeal infections, ARI, presence of foreign bodies (in young children, swallowing foreign objects such as coin-shaped batteries can cause esophageal rupture).
Patients may complain of fever, stiffness, shortness of breath or shortness of breath, or retrosternal chest pain which can radiate to the neck or back. If it is caused by a descending or decreasing infection, pain or obstruction in the neck can be felt, swelling in the neck, confusion or disorientation, an infection can be found in the wound in the sternum (breastbone).
Reason
There are two types of mediastinitis, namely acute and chronic. Acute mediastinitis often occurs suddenly. Meanwhile, chronic mediastinitis appears slowly and can be caused by long-term irritation or infection that takes a long time to heal.
There are several risk factors that make a person get mediastinitis. These risk factors include male gender and middle age, having diabetes and being immunocompromised, and drug users.
Mediastinitis is often caused by an infection. Some of the locations of the source of infection are:
- Structures in the mediastinum: rupture of the esophagus, blunt trauma to the chest or abdomen, granulomatous disease such as tuberculosis of the mediastinal lymph nodes, direct infection to the mediastinum (eg from the lung).
- Infection of the oropharyngeal area, often known as descending necrotizing mediastinitis: can originate from pharyngitis, tonsillitis, peritonsillar abscess, parapharyngeal abscess, otitis media, sinusitis, dental abscess, sialadenitis, infection after head and neck surgical procedures.
- Rare fibrotic reactions to granulomatous diseases, such as histoplasmosis. This condition causes fibrosing mediastinitis.
Diagnosis
Often the diagnosis of mediastinitis is made on the basis of clinical observation, that is, based on the history and physical examination. However, several supporting examinations can be carried out to help determine the diagnosis, including:
- Laboratory tests: shows increased markers for inflammation (white blood cells, C-reactive protein, erythrocyte sedimentation rate), blood cultures, and swabs from the source of infection.
- Imaging: X-ray of chest and neck, CT scan (recommended).
Some conditions that can give similar symptoms are pulmonary embolism, myocardial infarction, spontaneous pneumomediastinum, mediastinal tumors, cellulitis in the neck, mediastinal tuberculosis, and so on.
Treatment
Often patients with mediastinitis come in critical condition. Therefore one of the priorities is to stabilize the patient’s condition. Not infrequently sufferers need intensive care.
This condition is often caused by an infection. Therefore it needs to be treated with broad-spectrum antibiotics as soon as possible. If then the results of the microbial examination (culture, swab ) come out, then the type of antibiotic given can be adjusted.
Sometimes, mediastinitis requires surgical treatment. For example for debridement of necrotic tissue, drainage of pus, closure of esophageal rupture, and so on.
Mortality rates in cases of mediastinitis can vary, from 11–67 percent in circumstances where there are comorbidities. Considering that the fatality of this condition is quite high, it is best if all symptoms suspected of being mediastinitis are thoroughly evaluated as soon as possible and get treatment as soon as possible.