Acute Mediastinitis – Optimum Diagnostic and Therapeutic Measures

Czech version

Authors: J. Klečka ¹; V. Šimánek ¹; J. Vodička ¹; V. Špidlen ¹; R. Pradl ²; J. Ferda ³
Authors‘ workplace: Chirurgická klinika FN v Plzni, přednosta: prof. MUDr. V. Třeška, DrSc. ¹; Anesteziologicko-resuscitační klinika, přednosta: doc. MUDr. E. Kasal, CSc. ²; Radiologická klinika, přednosta: doc. MUDr. B. Kreutzberg, CSc. ³
Published in: Rozhl. Chir., 2009, roč. 88, č. 5, s. 253-258.
Category: Monothematic special - Original

Overview

The term of acute purulent mediastinitis (APM) is understood as a bacterial inflammatory process involving mediastinal tissue and organs. It is a group of clinical disorders originated primary or secondary as a complications another disease of different etiology. The definitive clinical picture is a combination of both pathologies [9].

APM having obviously purulent character develops usually extremly fast and is objectively harming patient’s life.

In case of Descending Necrotizing Mediastinitis (DNM) the mortality is up to 25–40% [4, 8, 11].

The only perfect and early stated diagnosis and choosen effective therapy mode can lead to patient life salvage and survival.

The surgery share on therapy is substantional.

During years 2004–2008 we have taken experience in this field by treatment of 18 patients with APM. Our conclusions after that most important condition for effective therapy is early and enough wide dissection of the involved area, mainly thoracocervical and mediastinal, their drainage and installation of the continual rinsing, eventually [6, 8, 9]. There is no exception we indicate an operative repeated revision including rethoracotomy, if necessary.

Key words:
acute purulent mediastinitis – primary and secondary infections – early diagnosis – CT image – optimal surgery decision – mediastinal dissection – drainage – rinsing drains – rethoracotomy

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