Mediastinitis, a model of care. Experience in the General Hospital of Mexico over 34 years (1982–2016)

Navarro-Reynoso, Francisco; Vargas-Abrego, Benito; Pérez-Romo, Alfredo; Cícero-Sabido, Raúl

doi:10.1016/j.hgmx.2016.10.002

Cited by 3 publications

(2 citation statements)

References 32 publications

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“…A new classification of mediastinitis is necessary to determine the exact indication of thoracotomy since endo's classification 6 Haz clic o pulse aquí para escribir texto.demands thoracotomy to all the patients that have affection below and posterior of the carina. At our hospital, we have a large data base of more than 1800 cases of mediastinitis to analyze every aspect of the disease and we can do a protocol to form the mentioned new proposal of classification 8 . Further information is necessary to know, if antibiotics are needed alone to avoid surgery in this group of patients.…”

Section: Discussionmentioning

confidence: 99%

Posterior basal segments atelectasis in descending necrotizing mediastinitis

Vargas-Abrego¹,

Navarro-Reynoso²,

Cícero-Sabido³

et al. 2021

HGMX

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Background:We have observed that patients with descending necrotizing mediastinitis show bilateral lower lobes atelectasis before pleural effusion that finally forms empyema. Successful treatment of mediastinitis emphasizes optimal early drainage of neck, mediastinum, and antibiotic therapy. Methods: Exploratory study to determine the presence of segmental atelectasis as incipient sign of mediastinitis. We studied patients from August 2018 to July 2019 with tomographies. Results: We evaluated 25 patients operated due to Mediastinitis at our hospital, from August 2018 to July 2019. Ten (40%) were females and 15 (60%) were male patients. Twenty-one (84%) patients showed atelectasis and 4 (16%) did not have atelectasis. Of the patients that showed atelectasis, 17 (81%) were bilateral, 2 (9.5%) were right sided, and 2 (9.5%) were left sided. We also analyzed the occurrence of pleural effusion in this group. Fifteen (60%) patients had pleural effusion and 10 (40%) did not. Of the total patients with pleural effusion 11 (73.3%) were bilateral, 3 (20%) of the right side, and 1 (6.6%) of the left side. Conclusions: Atelectasis is a sign that we can find in most patients that will develop empyema and we assume that it is associated with lymph nodes inflammation, but it is necessary to develop other protocols to confirm that hilar lymph congestion is the cause of atelectasis. As atelectasis of lower lobes is a sign of imminent sepsis, we always decide to do mediastinal drainage when we find them associated with neck abscess. We are proposing a modification of the endo classification to decide surgery.

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Section: Discussionmentioning

confidence: 99%

Posterior basal segments atelectasis in descending necrotizing mediastinitis

Vargas-Abrego¹,

Navarro-Reynoso²,

Cícero-Sabido³

et al. 2021

HGMX

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“…Mediastinitis is the inflammation of the connective tissue and fat surrounding the mediastinal structures. The entity is associated with high mortality (12 to 47%) [1][2][3]9 and mainly affects young people, with higher prevalence in men (4:1 ratio) 4 .…”

Section: Discussionmentioning

confidence: 99%

Hematogenous dissemination mediastinitis: case report

Martínez-Montalvo

Rodríguez

Reyes

et al. 2021

Infect

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Background: Acute mediastinitis is the inflammation of the connective tissue and fat surrounding the mediastinal structures. It is a high-mortality entity and its most frequent causes include sternotomy infections from cardiovascular surgery, esophageal perforation and extension of head and neck infections. Isolated cases of acute mediastinitis from hematogenous spread are described in the literature. Case presentation: 58 year-old man, with history of gouty arthritis managed with steroids, diagnosed with acute mediastinitis by S. aureus, secondary to septic arthritis of the ankle, managed with drainage of mediastinal collections by thoracoscopy and antibiotic therapy, with satisfactory evolution. Conclusions: In patients with acute mediastinitis, hematogenous dissemination should be considered when the etiologies most frequently associated with the entity are ruled out. Early surgical treatment derived from a multidisciplinary diagnostic approach improves the prognosis of these patients.

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