Mediastinitis may occur suddenly (acute) or may develop slowly, progressing over time (chronic). The majority of cases occur in patients who have had open chest surgery. This complication occurs in less than 5 percent of all patients who have open chest surgery.

Other patients who have a tear in their esophagus, either from excessive vomiting, trauma, or endoscopy, can also develop mediastinitis. Chronic or slowly developing mediastinitis can arise from tuberculosis, histoplasmosis, other fungal infections, cancer, or sarcoidosis.

Risk factors include recent chest surgery or endoscopy, problems in the upper gastrointestinal tract, and being at higher risk for infection, such as patients with impaired immune systems.

• Fever
• Chills
• Chest pain
• Shortness of breath
• Malaise

Signs of mediastinitis include chest wall tenderness, wound drainage, and an unstable chest wall in patients who have had recent surgery. A chest X-ray may show a widened mediastinum, caused by the collection of inflammatory cells within the chest.

A chest CT scan can show a more detailed view of the mediastinitis. Your health care provider may insert a needle into the area of inflammation and withdraw a sample to send for Gram stain and culture to identify the source of any infection.

If you have an infection, your health care provider will probably prescribe antibiotics. You may be given broad-spectrum antibiotics and then switched to a more specific antibiotic once the type of bacteria causing the infection is determined. This decreases the risk of side effects from the medication.

Often patients with mediastinitis must undergo surgery to debride (remove) the area of inflammation.

Prognosis depends on the cause. Patients who develop mediastinitis after open chest surgery have a significant risk of death as a result of the condition.

Complications include the following:

• Spread of the infection to surrounding structures:
  • heart
  • great vessels
  • lungs
  • bones
• Spread of the infection to the bloodstream
• Scarring

Scarring can be severe, especially when caused by chronic mediastinitis, and can compromise heart and/or lung function.

You should contact your health care provider if you have had open chest surgery and develop chest pain, fevers, chills, shortness of breath, or drainage from the incisions.

If you have tuberculosis or sarcoidosis and develop any of these symptoms, you should contact your health care provider right away.

The only way to prevent mediastinosis related to chest surgery is to keep surgical incisions clean and dry after surgery.

Treatment of underlying tuberculosis, sarcoidosis, or other condition associated with mediastinitis may prevent this complication.