Die akute und chronische Mediastinitis

Abstract

After perforation of the esophagus or trachea there is always the risk of an infection of the mediastinum; therefore, the diagnosis is followed by further evaluation and early therapy. The DNM can cause unspecific symptoms of sepsis without an obvious focal point. It is important to be aware of a possible correlation between an oropharyngeal center of infection and mediastinitis in order to initiate appropriate diagnostic imaging in cases with the slightest suspicion. Chronic mediastinitis is a rare condition with varying courses and can be difficult to diagnose. An histological clarification for distinction from malignant diseases appears to be a sensible approach.

Sepsis in Acute Mediastinitis – A Severe Complication after Oesophageal Perforations. A Review of the Literature

“…Clinical examination usually reveals tachypnoea, tachycardia, oedema of the face and neck, subcutaneous emphysema located at the level of the thorax and cervix, and Hamman’s sign with crunching sounds on auscultation of the heart [23, 24].…”

Acute Mediastinitis – Outcomes and Prognostic Factors of Surgical Therapy (A Single-Center Experience)

“…2,3,5) The majority (50%-75%) of these perforations are iatrogenically sustained during an endoscopic procedure (diagnostic or dilation), whereby the most common cause of spontaneous esophageal perforation is the Boerhaave syndrome (up to 33% of all perforations). 1,3,[5][6][7] In the past, DNM was mainly of odontogenic origin. However, with advancements in dental hygiene, the predominating infections are currently oropharyngeal.…”

“…However, with advancements in dental hygiene, the predominating infections are currently oropharyngeal. 2,[7][8][9][10][11] AM mainly affects individuals in their 50s or 60s, more often men, with risk factors such as diabetes mellitus type 2, alcohol or drug abuse, obesity, immunodeficiency, renal failure, or liver cirrhosis. 1,6,10,12) The infection is usually polymicrobial, aerobic and anaerobic, in which case the dominating strains are Streptococcus sp., followed by mycotic superinfections in up to half of the cases.…”

“…1,6,10,12) The infection is usually polymicrobial, aerobic and anaerobic, in which case the dominating strains are Streptococcus sp., followed by mycotic superinfections in up to half of the cases. 1,4,[7][8][9][10][11][12][13][14] The originally high mortality rate for AM of up to 50% has today fallen to below 20%. 7,11) The aims of this work were the retrospective analysis of a cohort of patients with AM treated at the authors' worksite over a 15-year period and the identification of factors that significantly affect the outcomes of the therapy.…”

“…1,4,[7][8][9][10][11][12][13][14] The originally high mortality rate for AM of up to 50% has today fallen to below 20%. 7,11) The aims of this work were the retrospective analysis of a cohort of patients with AM treated at the authors' worksite over a 15-year period and the identification of factors that significantly affect the outcomes of the therapy.…”