Book contents
- Frontmatter
- Dedication
- Contents
- List of Contributors
- Preface
- Part I Clinical syndromes: general
- Part II Clinical syndromes: head and neck
- Part III Clinical syndromes: eye
- Part IV Clinical syndromes: skin and lymph nodes
- Part V Clinical syndromes: respiratory tract
- Part VI Clinical syndromes: heart and blood vessels
- 37 Endocarditis of natural and prosthetic valves: treatment and prophylaxis
- 38 Acute pericarditis
- 39 Myocarditis
- 40 Mediastinitis
- 41 Vascular infection
- 42 Infections of cardiovascular implantable electronic devices and VAD
- Part VII Clinical syndromes: gastrointestinal tract, liver, and abdomen
- Part VIII Clinical syndromes: genitourinary tract
- Part IX Clinical syndromes: musculoskeletal system
- Part X Clinical syndromes: neurologic system
- Part XI The susceptible host
- Part XII HIV
- Part XIII Nosocomial infection
- Part XIV Infections related to surgery and trauma
- Part XV Prevention of infection
- Part XVI Travel and recreation
- Part XVII Bioterrorism
- Part XVIII Specific organisms: bacteria
- Part XIX Specific organisms: spirochetes
- Part XX Specific organisms: Mycoplasma and Chlamydia
- Part XXI Specific organisms: Rickettsia, Ehrlichia, and Anaplasma
- Part XXII Specific organisms: fungi
- Part XXIII Specific organisms: viruses
- Part XXIV Specific organisms: parasites
- Part XXV Antimicrobial therapy: general considerations
- Index
- References
40 - Mediastinitis
from Part VI - Clinical syndromes: heart and blood vessels
Published online by Cambridge University Press: 05 April 2015
- Frontmatter
- Dedication
- Contents
- List of Contributors
- Preface
- Part I Clinical syndromes: general
- Part II Clinical syndromes: head and neck
- Part III Clinical syndromes: eye
- Part IV Clinical syndromes: skin and lymph nodes
- Part V Clinical syndromes: respiratory tract
- Part VI Clinical syndromes: heart and blood vessels
- 37 Endocarditis of natural and prosthetic valves: treatment and prophylaxis
- 38 Acute pericarditis
- 39 Myocarditis
- 40 Mediastinitis
- 41 Vascular infection
- 42 Infections of cardiovascular implantable electronic devices and VAD
- Part VII Clinical syndromes: gastrointestinal tract, liver, and abdomen
- Part VIII Clinical syndromes: genitourinary tract
- Part IX Clinical syndromes: musculoskeletal system
- Part X Clinical syndromes: neurologic system
- Part XI The susceptible host
- Part XII HIV
- Part XIII Nosocomial infection
- Part XIV Infections related to surgery and trauma
- Part XV Prevention of infection
- Part XVI Travel and recreation
- Part XVII Bioterrorism
- Part XVIII Specific organisms: bacteria
- Part XIX Specific organisms: spirochetes
- Part XX Specific organisms: Mycoplasma and Chlamydia
- Part XXI Specific organisms: Rickettsia, Ehrlichia, and Anaplasma
- Part XXII Specific organisms: fungi
- Part XXIII Specific organisms: viruses
- Part XXIV Specific organisms: parasites
- Part XXV Antimicrobial therapy: general considerations
- Index
- References
Summary
The mediastinum is the space in the thorax between the lungs; it houses the heart, great vessels, esophagus, trachea, thymus, and lymph nodes. The connective tissues of the mediastinum are continuous with the long fascial planes of the head and neck, one reason why mediastinitis was primarily a complication of pharyngeal infections until the advent of thoracic surgery. By virtue of its deep position within the thorax, the mediastinum is a relatively protected organ space. There are four major portals of entry into the mediastinum: (1) direct inoculation of the mediastinum following sternotomy (i.e., postoperative mediastinitis [POM]); (2) spread along the long fascial planes of the neck (i.e., descending mediastinitis); (3) rupture of mediastinal structures, such as the esophagus; and (4) contiguous spread of infection from adjacent thoracic structures.
Postoperative mediastinitis
Postoperative mediastinitis (POM) is classified as an organ/space infection by Centers for Disease Control and Prevention (CDC) criteria and is a dreaded complication of median sternotomy. POM classically presents as a febrile illness with sternal wound dehiscence and purulent drainage, usually 2 to 4 weeks after sternotomy. Occasionally POM presents as a more chronic, indolent infection months to years after sternotomy. Sometimes, only superficial signs of infection are present, making POM difficult to diagnose. Frequently, a high index of clinical suspicion is required to differentiate POM from a more superficial sternal wound infection.
- Type
- Chapter
- Information
- Clinical Infectious Disease , pp. 268 - 272Publisher: Cambridge University PressPrint publication year: 2015