acute mediastinitis

Acute mediastinitis is a life-threatening condition requiring urgent intervention.

This study aims to describe the clinical, laboratory, imaging, and microbiological characteristics, as well as treatment outcomes, of acute mediastinitis cases.

A retrospective, descriptive study was conducted on 32 patients treated at the University Medical Center Ho Chi Minh City from February 2016 to April 2024. Data were collected on patient demographics, clinical features, laboratory results, imaging findings, microbiological cultures, and treatment outcomes.

The mean age was 55.7 years, with males comprising 59.4% of cases. Fever and chest pain were the most common symptoms. Staphylococcus aureus was the most frequently identified organism. Computed tomography (CT) scans typically showed mediastinal air-fluid levels and fat stranding. Surgical interventions included neck drainage and thoracotomy. Complications included severe sepsis, septic shock, and pneumonia, with a mortality rate of 9.4%.

Acute mediastinitis predominantly affects older males and presents significant clinical and diagnostic challenges. Effective multidisciplinary management is crucial for improving patient outcomes. This study provides valuable insights into the characteristics and treatment of acute mediastinitis in a Southeast Asian region.

Acute mediastinitis is a serious medical condition with a mortality rate of 30 to 40% or even higher. Early diagnosis with prompt and aggressive treatment is essential to prevent its rapid progression. We evaluated acute mediastinitis cases and analyzed the outcomes. A retrospective chart review was conducted on patients diagnosed with acute mediastinitis who were admitted to Mofid Children’s Hospital from January 2001 to January 2010. Seventeen patients aged 1 to 10 yrs. (mean =3.8 yrs) were evaluated including 12 (70%) boys and 5 (30%) girls. The most common symptoms were fever, dyspnea, cyanosis, tachycardia and tachypnea. The etiology of mediastinitis was iatrogenic esophageal perforation (EP), and related to manipulation in 13(77%), and leakage of esophageal anastomosis in 4 cases (33%). The underlying diseases were esophageal atresia in 2(12%), corrosive injury of the esophagus in 13(76%), congenital esophageal stenosis in one (6%), and gastroesophageal reflux esophagitis also in one (6%) patient. Patients with clinical symptoms were evaluated by immediate chest radiography, and gastrografin swallow. After early diagnosis, the patients received wide spectrum antibiotics and immediate mediastinal or thoracic drainage, followed by esophagostomy and gastrostomy. Only one case of endoscopic perforation was managed by NG tube. Fifteen patients (88%) survived successfully. We had 2(12%) cases of mortality in our study (one patient after esophageal substitution, mediastinal abscess and septicemia, and the other one developed esophageal perforation 6 months after early management and died of cardiac arrest during endoscopic dilation). Prevention of acute mediastinitis is still a difficult challenge. As the prognosis is not good and patients have high mortality, rapid management is mandatory.