Mediastinitis

Mediastinitis is an inflammation of the middle skin (mediastinum). Acute mediastinitis usually results from perforation of the esophagus or after heart surgery (median sternotomy). Symptoms include severe chest pain, shortness of breath, and fever. Mediastinitis is treated with antibiotics or surgery.

What is mediastinitis?

If the mediastinum - the tissue space in which all organs of the chest cavity are embedded - is affected by an infection, a serious and life-threatening disease develops. Delay in diagnosis or treatment can lead to death, with a death rate of 50% of cases.

Streptococci, Staphylococci and Pseudomonas are pathogens that Mediastinitis cause. The purulent inflammation of the tissue spreads through the blood vessels at high speed and infects the bloodstream and other parts of the body.

Mediastinitis causes significant scarring and disrupts the functioning of the heart and lungs. Chronic fibrosing mediastinitis narrows the tissue space and leads to long-term impairments such as thickened vascular muscles. Men of all ethnic groups between 30 and 50 years of age belong to the highest risk category.

causes

Cause one Mediastinitis is usually an infection. This can occur suddenly (acute) or develop slowly (chronic). It most commonly occurs as a result of perforation of the esophagus in patients who have had upper endoscopy or breast surgery.

Other causes of damage to the esophagus can include severe vomiting, the ingestion of toxic substances, or bruises (trauma).

Mediastinitis can also be caused by artificial respiration, infections of the teeth, gums, ears or sinuses, radiation or tuberculosis. Risk factors also include esophageal disease, diabetes, upper gastrointestinal problems, cancer, and a weakened immune system.

Typical symptoms & signs

• Fever and chills
• Chest pain
• Shortness of breath
• Throat swelling
• difficulties swallowing
• confusion

Diagnosis & course

From Mediastinitis Affected patients show symptoms such as fever and chills, shortness of breath, chest pain or pulling, and a general feeling of malaise.

You experience shortness of breath or pain in your throat. Some patients become seriously ill within a few hours and other symptoms may not show up until later. The diagnosis of mediastinitis is made using a computed tomography (CT) scan or a chest x-ray and is usually obvious based on the symptoms and medical history.

It should also be considered in patients who are very ill. To determine the type of infection, a needle can also be used to take a tissue sample from the area of ​​inflammation.

When should you go to the doctor?

Severe chest pain, fever, and breathing disorders are signs of an existing irregularity. A doctor's visit is necessary so that treatment can take place or an existing healing plan can be optimized. Mediastinitis is common in patients who have had heart surgery. Another risk group includes people with a perforation of the esophagus.

If the person concerned suffers acute shortness of breath, an ambulance service is required. After alerting him, first aid must be provided. A sufficient supply of oxygen must be guaranteed so that no life threat or premature death of the person concerned occurs.

If you have difficulty swallowing, mental confusion or disorientation, a doctor is needed. If there is shortness of breath over a longer period of time, the organism suffers from a lack of oxygen. A pale complexion, blue discoloration of the lips or a feeling of cold should therefore be presented to a doctor. If there is a pulling in the chest, abnormal heart rhythm or anxiety, a doctor should be consulted. Sleep disturbances, a general malaise and chills are further signs of a health impairment. If the symptoms persist for several days or if they intensify, a doctor should be consulted. Swelling in the neck area, a feeling of tightness in the throat or discomfort with food intake should be clarified by a doctor.

Treatment & Therapy

Treating a Mediastinitis is based on the causative factors and is definitely medication under medical supervision.

Patients who are ill as a result of a recent operation must have the surgical wound reopened, carefully cleaned and drained over several days. Necrotic or damaged tissue is removed. If the esophagus is ruptured or ruptured, the damaged area is treated and the infected area is drained.

Subsequent therapy with antibiotics such as ceftriaxone or clindamycin is usually scheduled for four to six weeks. The aim is to prevent mediastinitis from spreading to blood vessels, bones, heart and lungs and to prevent scarring. This is mainly caused by chronic mediastinitis. In this case, drugs that promote the breakdown of metabolic products (so-called corticoids) are used.

This is to prevent the proliferation of connective tissue in the affected organs. To prevent fungal infections, antimycotics can also be used in therapy. The treatment of chronic mediastinitis is extremely difficult and must therefore also be seen in connection with relief treatment methods to alleviate the effects of illness.

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Outlook & forecast

In most cases, patients with mediastinitis have a good prognosis. Regardless of the cause, there are various treatment options, which in the end often lead to freedom from symptoms. Nevertheless, if the disease progresses unfavorably, the person affected may die prematurely. Medicinal treatment is normally used. The affected person has to take medication for some time so that the damaged area on the esophagus can heal completely. Under optimal conditions, a symptom-free situation is documented within a few weeks.

If there are major injuries or complications arise, surgery is performed. This involves removing damaged tissue and taking measures so that the esophagus can then resume its full function. In the further healing process, drugs are also used to achieve optimal recovery. Here, too, the person affected will be completely free of symptoms within a few months.

In rare cases, chronic illnesses or an additional infection occur. In addition, complications and disturbances can occur during the surgical procedure. In these situations the prognosis is considerably worse. If cancer is found to be the cause of mediastinitis, further development is linked to the prospects for a cure for the primary disease. In a very unfavorable case, the patient is threatened with premature death.

prevention

The only preventive way to get one Mediastinitis as a consequence of an operation is the sterile care of the surgical wounds after an operation. Timely and successful treatment of tuberculosis, sarcoid, or other conditions associated with mediastinitis can avoid additional risks. This also includes the reliable healing of inflammatory processes in the head and chest area such as bronchitis or inflammation of the roots.

Aftercare

In many cases, mediastinitis is associated with severe complications and symptoms. Therefore, the disease must be treated by a doctor in any case, so that it does not lead to a reduction in the life expectancy of the person affected. The person affected should therefore consult a doctor at the first symptoms and complaints of the disease.

Most patients suffer from flu or cold symptoms from mediastinitis. Consistent follow-up care is therefore necessary in order to avoid a flare-up of the disease or a superinfection with bacteria. Follow-up care is initiated by the attending physician, usually the family doctor, and monitored if necessary.

Those affected should slowly find their way back to everyday life without overexerting themselves. First and foremost, this includes not stressing the body too early. Sport may only be practiced after consulting a doctor, in order not to expose the cardiovascular system too early to a great deal of stress.

Patients with serious or chronic comorbidities, pregnant women, people with a weak immune system, the elderly and small children should especially heed the follow-up instructions from their doctor. Then complete resolution of the mediastinitis can be realized to a high degree without relapses. A healthy lifestyle and rest are the two factors on which follow-up care is based.

You can do that yourself

If mediastinitis has been diagnosed, medical treatment is definitely required. The doctor will treat the inflammation with antibiotics or initiate an operation. You may be able to treat the individual symptoms yourself.

The difficulty swallowing can be relieved with home remedies such as warm honey or chamomile tea. In addition, there are various homeopathic remedies, such as the preparation Belladonna in potency D12 or the preparation arnica. Coughing and shortness of breath can be reduced by inhaling salt water solutions. However, appropriate measures should be discussed with a doctor beforehand in order to avoid complications. After an operation, rest and bed rest are primarily indicated. The body and especially the immune system is still very weak in the first few days of the procedure and must therefore be spared.

In consultation with the doctor, various home remedies can be used to promote healing. Warm pads, for example, as well as cooling measures have proven effective. To avoid severe scarring, the wound should be carefully cared for and regularly examined by a doctor. If complications become noticeable, a visit to the doctor is also indicated.