Diagnostic validity of computed tomography for mediastinitis after cardiac surgery.
BACKGROUND
Optimal treatment based on appropriate early diagnosis is essential in managing mediastinitis after cardiac surgery. We evaluated the accuracy of thoracic computerised tomography (CT) in the diagnosis of mediastinitis.


METHODS
Forty-one patients in whom we performed CT after cardiac surgery were classified into two groups as follows; Six cases had mediastinitis requiring a redo surgical intervention (Group M). Thirty-five cases recovered without mediastinitis (Group C). Comparisons of CT findings in both groups were made retrospectively.


RESULTS
In group M, CT and re-operations were performed 6.3+/-2.5 days and 8.0+/-5.2 days after previous operation, respectively. All but one of redo surgical procedures were mediastinal lavage and omental transplantation. Two patients died due to septic shock and multiple organ failure. CT in group M showed a soft tissue mass with contrast enhancement in 4 patients, bilateral pleural effusion in 5, free gas appearance in 4, and sternal dehiscence or destruction in 2 patients. Consequently, we regarded 4 of the 6 patients in this group as showing postoperative mediastinitis radiographically. In group C, CT performed 16.6+/-7.1 days after operations revealed findings suggestive of mediastinitis in 6 patients. Therefore, in terms of the validity of CT for the diagnosis of mediastinitis, the sensitivity was 67% and the specificity was 83%.


CONCLUSIONS
The sensitivity of CT for diagnosis of mediastinitis after cardiac operations is unsatisfactory. Diagnosis by seeking infective changes in a multidisciplinary way is important in dealing with mediastinitis.
Yamaguchi
H
H
Department of Cardiovascular Surgery, Oita Prefectural Hospital, Oita, Japan.
Yamauchi
H
H
Yamada
T
T
Ariyoshi
T
T
Aikawa
H
H
Kato
Y
Y
D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D016106:Methicillin Resistance; D008875:Middle Aged; D009852:Omentum / Q000637:transplantation; D012086:Reoperation; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013203:Staphylococcal Infections / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D013211:Staphylococcus aureus; D013492:Suppuration; D013530:Surgical Wound Infection / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D007507:Therapeutic Irrigation; D014057:Tomography, X-Ray Computed / Q000592:standards*