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Acute Mediastinitis – Optimum Diagnostic and Therapeutic Measures


Authors: J. Klečka 1;  V. Šimánek 1;  J. Vodička 1;  V. Špidlen 1;  R. Pradl 2;  J. Ferda 3
Authors‘ workplace: Chirurgická klinika FN v Plzni, přednosta: prof. MUDr. V. Třeška, DrSc. 1;  Anesteziologicko-resuscitační klinika, přednosta: doc. MUDr. E. Kasal, CSc. 2;  Radiologická klinika, přednosta: doc. MUDr. B. Kreutzberg, CSc. 3
Published in: Rozhl. Chir., 2009, roč. 88, č. 5, s. 253-258.
Category: Monothematic special - Original

Overview

The term of acute purulent mediastinitis (APM) is understood as a bacterial inflammatory process involving mediastinal tissue and organs. It is a group of clinical disorders originated primary or secondary as a complications another disease of different etiology. The definitive clinical picture is a combination of both pathologies [9].

APM having obviously purulent character develops usually extremly fast and is objectively harming patient’s life.

In case of Descending Necrotizing Mediastinitis (DNM) the mortality is up to 25–40% [4, 8, 11].

The only perfect and early stated diagnosis and choosen effective therapy mode can lead to patient life salvage and survival.

The surgery share on therapy is substantional.

During years 2004–2008 we have taken experience in this field by treatment of 18 patients with APM. Our conclusions after that most important condition for effective therapy is early and enough wide dissection of the involved area, mainly thoracocervical and mediastinal, their drainage and installation of the continual rinsing, eventually [6, 8, 9]. There is no exception we indicate an operative repeated revision including rethoracotomy, if necessary.

Key words:
acute purulent mediastinitis – primary and secondary infections – early diagnosis – CT image – optimal surgery decision – mediastinal dissection – drainage – rinsing drains – rethoracotomy


Sources

1. Akman, C., Kantarci, F., Cetinkaya, S. Imaging in mediastinitis: a systematic review based on etiology. Clin. Radiol., 2004 Jul., 59(7): 573–585.

2. Balkan, M. E., Oktar, G. L., Oktar, M. A. Descending necrotizing mediastinitis: a case report and review of the literature. Int. Surg., 2001 Jan-Mar, 86(1): 62–66.

3. Findikcioglu, A., Kilic, D., Akin, S., Hatipoglu, A. Descending necrotizing mediastinitis: treatment of a delayed case. Acta Chir. Belg., 2007 Jul-Aug: 107(4): 462–464.

4. Iwata, T., Sekine, Y., Shibuya, K., Yasufuku, K., Iyoda, A., Iizasa, T., Saito, Y., Fujisawa, T. Early open thoracotomy and mediastinopleural irrigation for severe descending necrotizing mediastinitis. Eur. J. Cardiothorac. Surg., 2005 Sep: 28(3). 384–388.

5. Keung, Y. K., Gendreau, J., Barber, A., Cobos, E. Acute media-stinitis secondary to leakage of parenteral nutrition from a migrated central venous catheter in a patient undergoing autologous bone marrow transplant. Bone Marrow Transplant.,1996 May: 17 (5): 871–872.

6. Maioli, M., Ghelma, F., Giacomini, M., Piovesana, G., Lowi, R., Mantovani, A. Descending necrotizing mediastinitis: report of two cases. Ann. Ital. Chir., 2008 May-Jun: 79(3): 209–211.

7. Merrill, W. H., Akhter, S. A., Wolf, R. K., Schneeberger, E. W., Flege, J. B. Jr. Simplified treatment of postoperative mediastinitis. Ann. Thorac. Surg., 2004 Aug: 78 (2): 608–612.

8. Mihas, P., Potaris, K., Gakidis, I., Papadakis, D., Rallis, G. Management of descending necrotizing mediastinitis. Oral Maxillofac. Surg., 2004 Aug: 62(8): 966–972.

9. Ragusa, M., Avenia, N., Fedeli, C., Puma, F., Calzolari, F., Semeraro, A., Daddi, G. Acute mediastinitis: clinical features and review of a case load. Chir. Ital., 2003 Jul-Aug: 55(4): 519–524.

10. Schroeyers, P., Wellens, F., Degrieck, I., DeGeest, R., Van Praet, F., Vermeulen, Y., Vanermen, H. Aggressive primary treatment for poststernotomy acute mediastinitis. Eur. J. Cardiothorac. Surg., 2001 Oct: 20(4): 743–746.

11. Singhal, P., Kejriwal, N., Lin, Z., Tsutsui, R., Ullal, R. Optimal surgical management of descending necrotizing mediastinitis, our experience and review of literature. Heart Lung Cirk., 2008 Apr.: 17(2). 124-8. Epub 2007 Dec. 3.

12. Voiriot, P., Marcoux, J. A., Duperval, R., Teijeira, J. Staphylococcus aureus mediastinitis: prognostic usefulness of an early medicosurgical therapy. Infect. Control, 1987, Aug: 8(8): 325–328.

13. Wheatley, M. J., Stirling, M. C., Kirsh, M. M., Gago, O., Orringer, M. B. Descending necrotizing mediastinitis: transcervical drainage is not enough. Ann. Thorac. Surg.,1990 May: 49(5): 780–784.

14. Brandler, E. S., Sinert, R. Mediastinitis : Overview – eMedicine,emedicine.medscape.com/article/ 784277- overview. Update Apr. 2, 2008.

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