emDocs - September 26, 2016 - Authors: Macdonald C, Scoccimarro A and Waseem M
Edited by: Alex Koyfman A and Long B
Pearls/Pitfalls
- Generally, patients with mediastinitis have manifestations of systemic infection, such as fever, chills, etc.
- Do not delay administering antibiotics if mediastinitis is suspected.
- Initial diagnosis is often clinical; no single test can confirm this diagnosis.
- Any surgical procedure on the neck, including tracheostomy, could result in mediastinitis.
- Post-sternotomy mediastinitis may mimic acute myocardial infarction.
- Hodgkin’s disease may resemble sclerosing mediastinitis.
- Fibrosing mediastinitis may result in superior vena cava syndrome.
- Fibrosing mediastinitis may mimic sarcoidosis.
- Mediastinitis may result in airway compromise; consider early protection of the airway.
- Mediastinitis may be mistaken for many conditions, such as pneumonia, acute coronary syndrome, etc.
- Spontaneous esophageal rupture may be mistaken for an abdominal catastrophe.
- Consider tertiary center referral, if resources are not optimal.
- The key to an optimal outcome is early diagnosis and aggressive treatment.