Mediastinum is the space between right and left pleurae. It contains heart and its vessels, trachea, esophagus, phrenic and cardiac nerves, thoracic duct, thymus, and lymph nodes of the chest. Inflammation of mediastinum is called as mediastinitis.

Causes and risk factors

Acute mediastinitis is cause by esophageal perforation or median sternotomy. Esophageal perforation is caused due to procedures like endoscopy, esophagoscopy, or treatment of esophageal varices. Tracheal instrumentation such as tracheostomy, tracheal biopsy, bronchoscopy, and endotracheal intubation can also cause perforation. Swallowing caustic substances or foreign bodies may also cause perforation. Certain drugs or esophageal ulcers can lead to perforation. Rarely, forceful vomiting leads to perforation of esophagus. Infections that lead to mediastinitis include pharyngitis, URTI, tonsillitis, sinusitis, dental infections, retropharyngeal abscess, suppurative thyroiditis, etc., chronic infections like TB, sarcoidosis also can lead to mediastinitis.

Clinical presentation

Patient presents with severe chest pain, fever, and dyspnea. There is general discomfort and shortness of breath. There is pain and tenderness of chest wall. Patient has fever with chills.


Medical history by the patient and clinical examination by the doctor helps in diagnosis. Chest x-ray, CT scan of chest confirms the diagnosis.


Treatment consists of adequate operative drainage of mediastinal cavity. Administration of antibiotics fully active against endotoxin-producing, gram-negative bacteria and obligate anaerobes contribute further to the treatment. Maintaining adequate airway is essential.

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