Mediastinitis

Overview

Mediastinitis is inflammation and infection of the mediastinum, the central compartment of the chest that lies between the lungs. This space contains vital structures including the heart and its great vessels, the esophagus, the windpipe (trachea), and many lymph nodes. An infection here can spread quickly and put pressure on these organs.

Mediastinitis can come on suddenly (acute) or develop slowly over months (chronic, often from scarring). The acute form is a medical emergency because infection in this confined, vital space can become overwhelming. Prompt treatment with antibiotics, drainage, and sometimes surgery saves lives. Because the mediastinum sits between the lungs and wraps around the heart and great vessels, an infection here is harder to contain than one in many other parts of the body, and even a small leak from the esophagus can seed bacteria into the space. Recovery often depends heavily on how quickly the problem is recognized and treated, which is why anyone with risk factors should not ignore sudden chest symptoms.

Symptoms

Acute mediastinitis usually causes severe, fast-developing symptoms. Chronic forms may be milder and develop gradually.

• Severe chest pain that may spread to the neck or back
• High fever, chills, and a fast heartbeat
• Difficulty breathing or rapid breathing
• Pain or difficulty swallowing
• Swelling, redness, or drainage from a recent chest surgical wound
• Feeling very unwell, weak, or confused

Severe chest pain with a high fever, trouble breathing, or a draining chest wound is an emergency. Call emergency services right away.

Causes

Bacteria reach the mediastinum in several ways:

• Esophageal tear: A hole in the esophagus, such as from esophageal perforation, lets food, saliva, and bacteria leak directly into the chest. This is a leading cause.
• After chest surgery: Heart or chest operations that open the breastbone can be followed by infection of the wound and the space behind it.
• Spread from nearby infection: A severe throat, tooth, or neck infection can travel down into the chest.
• Spread from the lungs or lymph nodes: Some infections, including certain chronic infections, cause inflammation and scarring of the mediastinum.

Risk Factors

• Recent open-heart or chest surgery
• An esophageal tear or recent procedure on the esophagus
• Severe dental, throat, or neck infections
• Diabetes or a weakened immune system
• Obesity, which can slow surgical wound healing
• Smoking

Diagnosis

Doctors combine the clinical picture with imaging and lab tests to confirm the diagnosis quickly.

• CT scan of the chest: The most useful test, showing fluid, gas, or infection in the mediastinum.
• Chest X-ray: May show a widened mediastinum or fluid.
• Blood tests: To detect infection and inflammation.
• Cultures: Fluid drained from the chest is tested to identify the bacteria and guide antibiotic choice.

Treatment

Acute mediastinitis is treated urgently, usually in the hospital and often in intensive care.

• Intravenous antibiotics: Strong antibiotics are started promptly to fight the infection.
• Drainage: Infected fluid and pus are drained from the chest, sometimes with tubes and sometimes during surgery.
• Treating the source: If a tear in the esophagus caused it, that tear is repaired or managed; an infected surgical wound is cleaned and treated.
• Supportive care: Fluids, oxygen, and close monitoring help the body recover.
• Repeat procedures: Some people need more than one operation to fully clean the infected space, and wound care may continue for weeks.

The length of treatment depends on the cause and how quickly the infection is controlled. Many people spend time in intensive care followed by a longer course of antibiotics and a gradual return to eating and normal activity as the infection clears.

Chronic mediastinitis caused by scarring is managed differently and may need treatment of the underlying disease or surgery to relieve pressure on chest structures.

Prevention

• Careful surgical technique and wound care after chest operations
• Prompt treatment of esophageal tears and severe dental, throat, or neck infections
• Good blood sugar control for people with diabetes before and after surgery
• Not smoking, which supports wound healing
• Reporting any redness, swelling, or drainage from a chest wound to your surgical team without delay

When to See a Doctor

Mediastinitis can be life-threatening. Seek emergency care immediately if you have:

• Severe chest pain with a high fever and fast heartbeat
• Trouble breathing
• Pain or inability to swallow after an esophageal procedure or vomiting
• Redness, swelling, or drainage from a recent chest surgical wound

If you have had recent chest surgery or an esophageal procedure and suddenly feel very unwell, contact your care team or emergency services right away.

Related Topics

Frequently Asked Questions

References

1. MedlinePlus, U.S. National Library of Medicine. Mediastinitis.
2. National Library of Medicine, StatPearls. Mediastinitis.
3. Mayo Clinic. Chest infections and the mediastinum.
4. American Association for Thoracic Surgery. Mediastinal infections.