What is Mediastinitis?
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Mediastinitis is a term used to describe all inflammatory processes of the connective tissue of mediastinal structures and involves spaces between serous membranes known as pleura. Due to the vital nature of the aforementioned structures, this condition is associated with a significant degree of morbidity and mortality. Most cases of mediastinitis necessitate the admission and subsequent treatment in the intensive care unit (ICU).
A mediastinal infection has many possible causes. The three most common ones are deep sternal wound infection, perforation of the esophagus, and descending necrotizing mediastinitis. Spread via blood from a remote focal infection has been described but is rarely observed. In any case, most cases are associated with cardiac surgery, usually following coronary artery bypass graft.
In addition to these acute types of mediastinitis, a rare chronic form (sclerosing mediastinitis or chronic fibrosing mediastinitis) may be caused by a granulomatous infection. The condition is not bacterial in nature, but stems due to leakage of fungal cell constituents from lymphatic nodes into the mediastinum, resulting in an immunogenic reaction and ebullient fibrotic response.
The anatomy of the mediastinum
The mediastinum represents the region between the lungs, located behind the breastbone (sternum) and in front of the thoracic part of the spine (vertebral column). It is viewed as a central section of the thoracic cavity, extending to the diaphragm from the thoracic inlet. It can also be further divided into the anterior, middle, and posterior mediastinum.
The anterior mediastinum includes the thymus gland, adipose tissue, lymphatic nodes, and internal mammary vessels. The middle mediastinum is bounded by pericardium and includes the heart and big vessels, the trachea and bronchi, lymphatic nodes, as well as essential nerves. Finally, the posterior mediastinum contains the esophagus.
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