[Mediastinitis].
Mediastinitis is defined as acute or chronic inflammation of the mediastinal structures and generally has a low incidence. The most frequent acute cause is sternotomy following cardiac revascularization surgery with both internal mammary arteries, with an incidence of 0.4% to 5% and a mortality of 16.5% to 47%. The most frequent vector is Staphylococcus aureus. Esophageal perforation, usually iatrogenic, is the second most frequent cause of acute mediastinitis, produced by common oropharyngeal flora, with a mortality rate of 20% to 60%, depending on the time of diagnosis. The third most frequent cause is descending necrotizing mediastinitis, the origin being an odontogenous focus in 60% and beta-hemolytic streptococcus the causative agent in 71.5% of cases. The most accurate diagnostic imaging technique is computed tomography. Treatment is almost always surgical and survival depends on its early performance. The worst postsurgical prognostic factor is septic shock.
Servicio Cirugía Torácica de Aragón, Hospital Universitario Miguel Servet, Zaragoza, España. Electronic address: p.martinezv@ono.com.
Primitivo
P
Martínez Vallina
Dionisio
D
Espinosa Jiménez
Lucía
L
Hernández Pérez
Ana
A
Triviño Ramírez
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003646:Debridement; D004322:Drainage; D004939:Esophageal Perforation / Q000150:complications / Q000382:microbiology; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis; D008478:Mediastinal Emphysema / Q000209:etiology; D008480:Mediastinitis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology / Q000601:surgery; D009055:Mouth / Q000382:microbiology; D011379:Prognosis; D017703:Retropharyngeal Abscess / Q000150:complications; D012772:Shock, Septic / Q000209:etiology / Q000401:mortality; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D056346:Sternotomy; D013290:Streptococcal Infections / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000382:microbiology
D000900:Anti-Bacterial Agents