[Acute mediastinitis except in a context of cardiac surgery].
Acute mediastinitis is a life-threatening complication (20 to 40 % of mortality) secondary to oropharyngeal abscesses, neck infections or oesophageal leak spreading into the mediastium. Early diagnosis and optimal therapeutic approach are crucial for patient survival. CT scanning of the cervical and thoracic area is a useful tool for diagnosis and follow-up. Treatment is based on broad-spectrum antibiotherapy, adequate surgery, mediastinal drainage, and treatment of possible organ failure. There is no surgical standardized attitude. Mini-invasive approach could be satisfactory when prompt diagnosis is established and the thoracic drainage is effective. Repeated postoperative CT scanning and close clinical and laboratory monitoring could make an additional thoracotomy a second-line procedure.
Doddoli
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Service de Chirurgie Thoracique et des Maladies de l'Oesophage, Hôpital Sainte-Marguerite, 270 boulevard de Sainte-Marguerite, 13274 Marseille cedex 9, France. christophe.doddoli@mail.ap-hm.fr
Trousse
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Avaro
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Djourno
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Giudicelli
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Fuentes
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Thomas
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D000208:Acute Disease; D000970:Antineoplastic Agents / Q000627:therapeutic use; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D003131:Combined Modality Therapy; D004322:Drainage; D005500:Follow-Up Studies; D006801:Humans; D008480:Mediastinitis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D008482:Mediastinum / Q000473:pathology / Q000601:surgery; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects; D008826:Microbial Sensitivity Tests; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D012086:Reoperation; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed
D000970:Antineoplastic Agents