CT Evaluation of Mediastinal Infections

Carrol, Clark L.; Jeffrey, R. Brooke; Federle, Michael P.; Vernacchia, F S

doi:10.1097/00004728-198705000-00015

Cited by 62 publications

(37 citation statements)

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“…Because of this limitation, a variety of diagnostic approaches to the diagnosis of mediastinitis have been evaluated, including aspiration of the mediastinal space, 14,15 ␣ 1 acid glycoprotein and C-reactive protein measurements, 16 procalcitonin level, 17 and culture of perioperative instruments. 18 Even advanced, expensive methods of radiographic imaging such as computed tomography, 19,20 fluorine-18 fluorodeoxyglucose positron emission tomography, 21,22 gallium-67 scintigraphy, 23 99Tcm-labeled leukocyte scintigraphy, 24,25 or single photon emission computed tomography with 99mTc-hexamethylpropylene amine oxime-labeled leukocytes 26 are either of limited benefit in identifying patients with postoperative mediastinitis or are widely unavailable. For example, the sensitivity and positive predictive value of computed tomography in the diagnosis of mediastinitis were as low as 25% and 71%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Staphylococcus aureus Bacteremia After Median Sternotomy

et al. 2003

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Background-Mediastinitis is a complication of coronary artery bypass graft surgery (CABG) that can be difficult to diagnose. This study evaluated the utility of blood culture results in identifying patients with mediastinitis. Methods and Results-All unique patients undergoing CABG at our institution over a 60-month study period (nϭ5500) and all blood cultures performed on these patients Յ90 days after CABG were identified.

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Section: Discussionmentioning

confidence: 99%

Staphylococcus aureus Bacteremia After Median Sternotomy

et al. 2003

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“…It is important to note that some CT signs suggestive of mediastinitis can be seen in asymptomatic patients up to 21 days following median sternotomy [27,28]. Thus, correlation between clinical and radiological findings is imperative in these patients.…”

Section: Clinical Presentation and Risk Factorsmentioning

confidence: 99%

Descending necrotising mediastinitis: two case reports and review of the literature

Weaver¹,

Nguyen²,

Brooks³

2010

Eur Respir Rev

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Descending necrotising mediastinitis is a rare and serious infection with a high mortality rate, which complicates pharyngeal or odontogenic infection. Early recognition and treatment are essential in order to minimise morbidity. Evaluation with computed tomography is necessary to confirm the diagnosis and facilitate surgical planning. In addition to prompt empirical antiobiotic therapy, surgical intervention is necessary in nearly all cases. Surgical drainage and debridement may be performed through cervicotomy alone, or through combined cervicotomy and thoracotomy, depending upon the extent of disease. Hyperbaric oxygen therapy may play an auxiliary role. We present two recent cases with characteristic imaging findings, and review the relevant literature. KEYWORDS: Computed tomography, mediastinitis CASE ONEA 60-yr-old male presenting with neck swelling, dysphagia and hoarseness had been extubated 2 days previously following a pneumonia. He had a past medical history of laryngeal cancer treated 10 yrs ago with external beam radiation and chemotherapy. On examination he had bilateral diffuse neck erythema, oedema and right-sided induration. Fibre-optic laryngoscopy showed scabbing of the right hypopharynx and erythematous swelling of the false vocal folds, aryepiglottic folds, and epiglottis. Over the course of 12 h, he developed septic shock with a blood pressure of 70/ 30 mmHg, heart rate of 135 beats?min, and a temperature of 103uF. He was started empirically on vancomycin and piperacillin/tazobactam. After stabilisation in the intensive care unit (ICU), computed tomography (CT) imaging of the neck and chest was performed. There was a large amount of subcutaneous air tracking into the deep fascial planes of the anterior neck, oedematous laryngeal mucosa, and bilateral loculated fluid collections tracking throughout the anterior neck extending to the superior mediastinum ( fig. 1). CT imaging of the chest showed a complex air and fluid collection in the anterior mediastinum extending to the base of the neck ( fig. 2). After review of the images, the patient was taken to the operating room for a combined procedure performed by both head and neck surgeons and thoracic surgeons. Bilateral anterior neck dissections were performed, and blunt dissection, irrigation and debridement were carried out to several centimeters below the sternal manubrium. Penrose drains were left in place. Then, left anterior thoracotomy with debridement of the anterior mediastinum, left pleural decortication and a pericardial window were performed by the thoracic surgeons. Microbiology of the anterior mediastinal fluid grew multiple organisms including Fusobacterium, Prevotella, Bacteroides fragilis, Peptostreptococcus, and a heavy growth of Streptococcus intermedius. Pathology of the pharyngeal lesions showed necrosis and granulation tissue. No neoplasm was identified. The patient later received a tracheostomy and pectoralis myocutaneous flap repair of the neck without sequelae. His total ICU length of stay was 32 days, and hi...

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“…Chronic fibrosing mediastinitis is usually secondary to previous granulomatous infection, the most common organism being Histoplasma capsulatum [1][2][3][4][5][6][7]. Studies have shown a peak incidence in young adults, with a slight male predominance [2][3][4][5].…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, acute mediastinitis has mortality of 60-80 % [7] and is most commonly seen following cardiothoracic surgery or in patients with esophageal perforation secondary to instrumentation, trauma, emesis or foreign body impaction [5]. Presenting symptoms usually include chest pain, fever and dyspnea [5,7].…”

Section: Discussionmentioning

confidence: 99%