Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Mediastinitis”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 19 recordsLinked to original sources
PubMed1983

Comparison of mediastinal width, mediastinal-thoracic and -cardiac ratios, and "mediastinal widening" in detection of traumatic aortic rupture.

This study was undertaken to determine whether direct measurement of mediastinal width or computation of ratios of measurements of easily detectable mediastinal structures is more effective than the subjective impression of "mediastinal widening" in selecting trauma patients for aortography. A group of five surgeons and radiologists individually read in blinded fashion 149 chest films of trauma victims who had undergone aortography to rule out traumatic rupture of the aorta (TRA). Each made a subjective interpretation of "mediastinal widening," as well as direct measurement of mediastinal width (MW), thoracic width at the level of the mediastinum, cardiac width, and maximum thoracic width. Mediastinal-cardiac (MC), mediastinal-thoracic (MT), and mediastinal-mediastinothoracic (MMT) ratios were calculated. Statistically significant differences were found in all parameters of direct measurement between cases with and without TRA (P from .0001 for MT to .01 for MMT). The critical measurement for mediastinal width separating positive from negative cases was 8.0 cm; the critical ratios were MT = 0.275, MC = 0.555, and MMT = 0.36. Application of these parameters to detect TRA yielded sensitivities of .75 for MW, .68 for MC, .66 for MMT, and .62 for MT. Statistically significant differences between observers' measurements were seen. None of these measurements was as effective as subjective interpretation of mediastinal widening, which had a sensitivity of .91 (P = .0000). We conclude that the subjective impression of mediastinal widening is superior to "objective" direct measurement of mediastinal structures for identification of trauma patients with aortic rupture.

Aorta↗
PubMed2004

Left mediastinal width and mediastinal width ratio are better radiographic criteria than general mediastinal width for predicting blunt aortic injury.

BACKGROUND: General mediastinal width, left mediastinal width, and mediastinal width ratio were compared as radiographic predictors of aortic injury. METHODS: A retrospective study investigated the chest radiographs of 51 patients admitted to a level 1 trauma center during a 6-year period for a thorough survey of aortic injury. Mediastinal width (MW >/= 8 cm), left mediastinal width (LMW >/= 6 cm), mediastinal width ratio (MWR >/= 0.60), and a combination of LMW and MWR were compared as predictors of aortic injury. The cutoff points were predetermined by receiver-operator-curve to accommodate 100% sensitivity for each criterion. RESULTS: Of the 51 patients, 21 had aortic injuries and 30 had normal imaging studies. All criteria had 100% negative predictive value. The specificities and positive predictive values, respectively, were 13.3% and 44.7% (MW), 40.0% and 53.8% (LMW), 43.3% and 55.3% (MWR), and 66.7% and 67.7% (combined LMW and MWR). The positive likelihood ratio of aortic injury was 3.00 when LMW was 6 cm or more and MWR was 0.60 or more. CONCLUSIONS: Both an LMW of 6 cm or more and an MWR of 0.60 or more are better radiographic criteria than an MW of 8 cm or more for predicting blunt aortic injury. Trauma patients with positive test results based on the combined LMW and MWR criteria should proceed immediately to aortography or helical computed tomography.

Adolescent↗
PubMed1994

Descending necrotizing mediastinitis. Advantage of mediastinal drainage with thoracotomy.

Descending necrotizing mediastinitis can occur as a complication of oropharyngeal and cervical infections that spread to the mediastinum via the cervical spaces. Delayed diagnosis and inadequate mediastinal drainage through a cervical or minor thoracic approach are the primary causes of a high published mortality rate (near 40%). Between 1985 and 1992, six men (mean age, 49 years) with descending necrotizing mediastinitis were surgically treated at our institution. The primary oropharyngeal infection was peritonsillar abscess (three cases) and odontogenic abscess (three cases). In all cases, occurrence of respiratory insufficiency associated with serious cervical infection suggested the mediastinitis diagnosis. Computed tomographic scans confirmed the mediastinitis, showing mediastinal abscess and mediastinal emphysema. All patients underwent surgical drainage of the deep neck infection combined with mediastinal drainage through a thoracic approach. The outcome was favorable in five patients who had mediastinal drainage through a thoracotomy; the patient who had mediastinal drainage through a minor thoracic approach (anterior mediastinotomy) died of tracheal fistula on postoperative day 18. In our experience, aggressive mediastinal drainage by a thoracotomy approach regardless of the level of mediastinal involvement led to improvement in survival of these patients, with a 17% mortality rate.

Adult↗
PubMed1997

[Investigation into mediastinal lymph node metastasis of lung cancer and rationale for decision of the extent of mediastinal dissection].

UNLABELLED: From the study on the regional lymphatic drainage and investigation into mediastinal lymph node metastasis of lung cancer, we have decided the extent of mediastinal dissection as follows; 1) For right lung cancer, as the routine procedure, extended systematic ipsilateral mediastinal dissection including the left tracheobronchial region, the anterior and the posterior ipsilateral mediastinum through a conventional thoracotomy. 2) For left lung cancer, as the routine procedure, systematic bilateral mediastinal dissection through a median sternotomy. 3) For the patients with advanced lymph node metastasis (the highest mediastinal or the cervical node involvement) or direct extension into the upper mediastinum of cancer in any side of the lungs, the lower half of modified radical neck dissection combined with systematic bilateral mediastinal dissection through a cervical collar incision and median sternotomy. RESULTS: 1. The noteworthy location and incidences of mediastinal lymph node involvement were as follows; 1) Among 34 patients of right lung cancer with pN2-3 M0 disease, in 5 patients the anterior mediastinal node involvement and in 6 patients (18%) the contralateral tracheobronchial node involvement were found by the pathological investigation at surgery. 2) The incidences of contralateral mediastinal node involvement at median sternotomies were 20% of 15 patients of the left upper lobe primary and 57% of 7 patients of the left lower lobe primary. 2. Postoperative survival rates calculated with Kaplan-Meier method; 1) The five-year survival rates were 67% in 22 patients with pT1-2N2M0; 72% in 20 patients with pT1-2N2-3 alpha (one level) M0 and 65% in 13 patients with pT1-2N2-3 alpha (multi level) M0. 2) The five-year survival rate of 8 patients with N3 gamma whose cancer were diagnosed as cN0-3 alpha preoperatively and resected completely was 60%. In conclusion, these results encourage us to continue this study because we can believe that our systematic mediastinal dissection beyond the anatomical difficulties would bring better prognoses in the patients with pN2-3 disease.

Humans↗
PubMed2003

Autotransfusion of shed mediastinal blood: a risk factor for mediastinitis after cardiac surgery? Results of a cluster investigation.

RATIONALE: After the introduction of autotransfusion of shed mediastinal blood following cardiac surgery, the incidence of mediastinitis increased. The role of autotransfusion in the increased occurrence of this serious complication was examined. METHODS: Using a case-control design, the preoperative, intraoperative, and postoperative characteristics of 11 patients with mediastinitis were compared to those of 33 randomly selected patients undergoing cardiac surgery between September 1, 2000, and April 15, 2001 (control subjects). RESULTS: Patients with mediastinitis were significantly more likely to have a body mass index > 30 (unadjusted odds ratio [OR], 9.9; 95% confidence interval [CI], 2.3 to 42.5), to have received antibiotic therapy during the 2 weeks prior to cardiac surgery (OR, 12.0; 95% CI, 1.1 to 131), or to have required re-exploration within 24 h of the original operation (OR, 8.3; 95% CI, 1.8 to 39). Patients with mediastinitis had 3.4 known risk factors for mediastinitis, compared to only 1.4 risk factors per control subject (p = 0.0001), and longer duration of autotransfusion. After adjustment for other risk factors, autotransfusion for > 6 h was significantly associated with the development of mediastinitis (adjusted OR, 11.9; 95% CI, 1.4 to 97.2). CONCLUSION: Retransfusion of shed mediastinal blood for > 6 h after cardiac surgery was an independent risk factor for mediastinitis.

Aged↗
PubMed1997

[Mediastinal metastasis of differentiated thyroid cancers. Treatment by total mediastinal curettage in 9 cases].

Nine patients with mediastinal lymph node metastasis in differentiated thyroid carcinoma (7 papillary carcinomas, 1 Hürtle's cells carcinoma, 1 insular carcinoma) have been treated by systematic mediastinal dissection, 2 cases arose 6 and 10 years after the initial surgery, 2 cases after 18 and 20 months, but 5 revealed their metastases at the moment of the diagnosis or 3 months later. Investigations caused by a rise in thyroglobuline level (4 cases) necessarily involve a mediastinal CT scan, which always proved conclusive. All the patients underwent a median total sternotomy associated with a cervicotomy either for total thyroidectomy with conservative bilateral neck dissection, or for revision of the initial dissection. We describe the technique of mediastinal dissection allowing the resection of all the mediastinal lymph nodes. Mortality was zero and morbidity remained reasonable. 3 patients had recurrences: 2 died from multiple diffused metastases 18 months later, the third has pulmonary and mediastinal metastases well controlled by radio-iodine and external radiotherapy with a 5 years follow-up 6 are under total remission without sequel with a follow up ranging from 6 months to 8 years. Rather uncommon, total mediastinal dissection gives a long lasting remission with good living conditions to patients unresponsive to other therapies.

Adenocarcinoma↗
PubMed1989

Determination of normal transverse mediastinal width and mediastinal-width to chest-width (M/C) ratio in control subjects: implications for subjects with aortic or brachiocephalic arterial injury.

We measured transverse mediastinal width and mediastinal-width to chest-width (M/C) ratio on supine films of 100 nontraumatized controls. In 95% the transverse mediastinal width was less than 7.5 cm and the M/C ratio was less than 0.38. Thus a transverse width of 7.5 cm or more or an M/C ratio of 0.38 or more can be defined as abnormal with 95% confidence. Application of these values to determine abnormality in 32 patients with proven aortic or brachiocephalic injury showed that the transverse mediastinal width was within normal limits in 41% and M/C ratio was normal in 69%. Utilizing smaller values that would identify all abnormals resulted in false positive rates in the controls of 74% and 87%, respectively. However, one or more of eight specific signs of mediastinal abnormality related to hemorrhage or pseudoaneurysm formation were present in 94% of abnormals compared to only 11% of controls. Because of extreme overlap of transverse mediastinal width and M/C ratio between normals and abnormals, precise measurement of the mediastinum cannot reliably separate the two groups. The subjective assessment of anatomic mediastinal abnormality remains a superior plain film method in determining the need for aortography.

Adolescent↗
PubMed1998

Mediastinal lymphadenopathy and hazy mediastinal fat: new CT findings of congestive heart failure.

OBJECTIVE: We describe two new CT findings of congestive heart failure (CHF): enlarged mediastinal lymph nodes and hazy heterogeneous mediastinal fat. MATERIALS AND METHODS: Forty-six patients were retrospectively identified who had major and minor clinical signs of congestive heart failure and had undergone chest CT during their symptomatic period. Two radiologists reviewed the CT studies and by consensus documented the presence or absence of imaging findings of CHF, including interstitial abnormalities, vascular redistribution, axial thickening, pleural effusions, cardiac enlargement, and mediastinal abnormalities. RESULTS: Smooth septal thickening, bilateral pleural effusions, vascular redistribution, and cardiac enlargement were the most common CT findings in patients with CHF. Enlarged mediastinal lymph nodes and hazy mediastinal fat were seen in 55% and 33% of cases, respectively. In a cohort of 17 patients with elevated pressures in the pulmonary capillary wedge documented within 24 hr of CT, CT scans revealed lymphadenopathy in 14 patients (82%) and inhomogeneous fat in 10 patients (59%). CONCLUSION: Enlarged mediastinal lymph nodes and hazy mediastinal fat occur in patients with CHF and are revealed by CT. Lymphadenopathy in patients with CHF does not necessarily indicate malignancy or an infectious process.

Adipose Tissue↗
PubMed2004

[Clinical evaluation of management of superior mediastinal metastasis from thyroid carcinoma with systemic superior mediastinal dissection via sternotomy approach: 12 cases report].

BACKGROUND & OBJECTIVE: Few research of surgery for superior mediastinal metastasis from thyroid carcinoma has been reported. Previous surgical approach from neck had the problems of easy damage of nerve and vessels and the difficulty of clearance of lymph nodes. This study was designed to assess the value of systemic superior mediastinal lymph node dissection via sternotomy for superior mediastinal metastasis from differentiated thyroid carcinoma. METHOD: A retrospective study was performed to analyze the clinical pathologic data as well as the outcome of 12 cases of differentiated thyroid carcinoma treated with systemic superior mediastinal lymph node dissection via sternotomy approach from April 1995 to April 2002, including 7 cases of papillary adenocarcinoma and 5 cases of medullary carcinoma. RESULTS: Pathologically, the incidence rates of metastasis to anteriotracheal lymph node, paratracheal lymph node, anterior superior vena cava, and anterior innominate artery lymph nodes were 55.6% (25/45), 57.1% (36/63), 42.1% (8/19) and 30% (3/10), respectively. All cases are still alive in one to seven years follow-up period. The median follow-up was 32 months. Upper mediastinal lymph nodes were recurrent in one case; distant metastasis occurred in two cases. CONCLUSION: Systemic superior mediastinal lymph node dissection via sternotomy approach can be employed in treating superior mediastinal lymph node metastasis from differentiated thyroid carcinoma due to its safety and relatively satisfactory outcome.

Adenocarcinoma, Papillary↗
PubMed1987

Mediastinal trauma and other acute mediastinal conditions.

Acute mediastinal diseases most often result from penetrating or blunt trauma and from iatrogenic injuries related to the misplacement of tubes and catheters. The commonest chest film findings of mediastinal disease include mediastinal contour alteration, such as obliteration of normal structures, mediastinal widening, and pneumomediastinum. Characteristic mediastinal findings indicating injury to specific mediastinal structures are presented.

Acute Disease↗
PubMed2000

[A case of anterior mediastinal abscess with skin fistula resulting from descending necrotizing mediastinitis].

Descending necrotizing mediastinitis (DNM) is a serious, life-threatening infection. We present a case of anterior mediastinal abscess resulting from DNM. A 43-year-old woman, who had underwent cervical drainage for DNM 4 months ago, visited our hospital for cervical fistula. Chest CT revealed anterior mediastinal abscess. Mediastinal drainage through a subxiphoidal incision, debridement via the parasternal approach and resection of cervical fistula were performed without thoracotomy. A continuous mediastinal irrigation by acid water was performed postoperatively. The culture of the drain fluid became negative, and mediastinal abscess was disappeared. In conclusion, immediate and suitable drainage, debridement and postoperative-irrigation are important for DNM. On chronic stage, management to defend from extending infection is needed.

Abscess↗
PubMed2006

Poststernotomy mediastinitis: a review of conventional surgical treatments, vacuum-assisted closure therapy and presentation of the Lund University Hospital mediastinitis algorithm.

Poststernotomy mediastinitis, also commonly called deep sternal wound infection, is one of the most feared complications in patients undergoing cardiac surgery. The overall incidence of poststernotomy mediastinitis is relatively low, between 1% and 3%, however, this complication is associated with a significant mortality, usually reported to vary between 10% and 25%. At the present time, there is no general consensus regarding the appropriate surgical approach to mediastinitis following open-heart surgery and a wide range of wound-healing strategies have been established for the treatment of poststernotomy mediastinitis during the era of modern cardiac surgery. Conventional forms of treatment usually involve surgical revision with open dressings or closed irrigation, or reconstruction with vascularized soft tissue flaps such as omentum or pectoral muscle. Unfortunately, procedure-related morbidity is relatively frequent when using conventional treatments and the long-term clinical outcome has been unsatisfying. Vacuum-assisted closure is a novel treatment with an ingenious mechanism. This wound-healing technique is based on the application of local negative pressure to a wound. During the application of negative pressure to a sternal wound several advantageous features from conventional surgical treatment are combined. Recent publications have demonstrated encouraging clinical results, however, observations are still rather limited and the underlying mechanisms are largely unknown. This review provides an overview of the etiology and common risk factors for deep sternal wound infections and presents the historical development of conventional therapies. We also discuss the current experiences with VAC therapy in poststernotomy mediastinitis and summarize the current knowledge on the mechanisms by which VAC therapy promotes wound healing. Finally, we suggest a structured algorithm for using VAC therapy for treatment of poststernotomy mediastinitis in clinical practice.

Algorithms↗
PubMed2005

Idiopathic mediastinal fibrosis presenting as mediastinal compression syndrome.

Mediastinal compression syndrome is a commonly seen entity. Mediastinal compression, mostly due to a space-occupying lesion, is distinct and different from mediastinitis/mediastinal fibrosis, which could also lead to superior vena cava syndrome. Idiopathic mediastinal fibrosis should also be considered as differential diagnosis of mediastinal structures with various radiological, CT and MRI and histological features if feasible. Medical therapy is disappointing while surgical cure has limitations. This interesting patient presented as mediastinal compression syndrome, which on investigation was postulated as idiopathic mediastinal fibrosis, as a diagnosis on exclusion of other causes, which is rare, hence is being reported.

Adult↗
PubMed2002

Mediastinal granuloma and mediastinal fibrosis.

Mediastinal granuloma/mediastinal fibrosis is a chronic inflammatory disease of the mediastinum. Mediastinal granuloma is the abnormal enlargment of mediastinal lymph nodes by granulomatous inflammation, is usually asyptomatic or minimally symptomatic, and is often detected on chest radiographs taken for other reasons. In contrast, mediastinal fibrosis is extensive fibrous tissue throughout the middle mediastinum causing compression, encasement, or invasion of the large bronchi, superior vena cava, pulmonary veins, or esophagus, often with serious clinical consequences. Some patients may exhibit a clinical entity characterized by enlarged fibrotic and/or calicified lymph nodes with a variable amount of fibrosis that may be asymptomatic, or may cause symptoms by compression or invasion of structures in the mediastinum. Clinical manifestations may be due to superior vena cava (SVC) obstruction, esophageal compression, large airway involvement, pulmonary artery or pulmonary vein narrowing, or laryngeal or phrenic nerve impingement. Definitive diagnosis is traditionally made on the basis of a surgical exploration and biopsy, either a mediastinoscopy or thoracotomy; however, characteristic findings on computed tomography (CT) of the chest may be sufficient for a diagnosis in a certain number of cases. The best therapy is unknown. Antifungal therapy and corticosteroids have been reported effective in some cases. Surgical resection of localized mediastinal granuloma or fibrosis causing symptoms is often effective. However, surgical resection of extensive mediastinal fibrosis usually is not feasible.

Journal Article↗
PubMed1979

Mediastinal granuloma and fibrosing mediastinitis.

Thirty-one patients with mediastinal granuloma and fibrosing mediastinitis were seen at the Mayo Clinic from 1975 through 1977. Review of this series reveals that surgery is necessary to establish a diagnosis if the lesions are noncalcified and indeterminate. Fibrosing mediastinitis most likely develops after rupture of the fibrocaseous material from mediastinal lymph nodes into the mediastinum. Thoracotomy, with evacuation of the granulomas, is recommended, especially when the lesions are large, in order to prevent subsequent fibrosing mediastinitis with involvement of the contiguous structures, such as the superior vena cava, azygos vein, trachea, esophagus, and left atrium. In most patients, obstruction of the superior vena cava develops slowly, and efficient collateral venous circulation occurs, allowing long-term survival and minimal disability.

Adolescent↗
PubMed1994

Mediastinal ultrasonography for the assessment of mediastinal lymph node metastases in lung cancer patients.

Using an ultrasonic probe inserted into the mediastinum during cervical mediastinoscopy, mediastinal ultrasonography (USM) was performed on 63 patients with lung cancer. The patients with a small peripheral mass of less than 2 cm in diameter, according to the chest X-ray results, and with mediastinal lymph nodes smaller than 1 cm in their short axes as determined by computed tomography (CT), were excluded from this study. An analysis of the areas under the receiver operating characteristic curves derived from CT and USM showed that USM was superior (P = 0.043) to CT in terms of the diagnosis for mediastinal lymph node metastases, when the short axis dimension of mediastinal lymph nodes was employed for the diagnosis of metastases. The reason for this is that 97% of the mediastinal lymph nodes imaged by USM were located vertically along the body axis of the patient, and hence USM imaged the true short axis of the node in many cases. Our results indicate that USM is useful for performing a safe biopsy of lymph nodes during mediastinoscopy as well as for obtaining a clear imaging of the subcarinal nodes, which are inaccessible by normal cervical mediastinoscopy.

Adult↗
PubMed1983

Nontraumatic suppurative mediastinitis presenting as acute mediastinal widening.

A case of acute nontraumatic suppurative mediastinitis in a 56-year-old man is presented. The patient was admitted with signs and symptoms of a left lower lobe pneumonia and acutely developed mediastinal widening on chest radiograph. A mediastinal abscess was drained by posterior mediastinotomy after a complicated hospital course. Mediastinitis is a rare complication of pneumonia. It is a serious condition, requiring prompt diagnosis and aggressive therapy, and should be considered in the differential diagnosis of acute mediastinal widening.

Anti-Bacterial Agents↗