Acute mediastinitis: spectrum of computed tomography findings

Abstract

The objective of this study was to describe CT findings and to determine the diagnostic value of CT in diagnosis of acute mediastinitis. CT findings were retrospectively studied in 40 patients with suspected acute mediastinitis, including 28 postoperative patients, five with acute descending necrotizing mediastinitis (ADNM), and seven with suspected post-traumatic perforation of the esophagus. Findings included increased attenuation of mediastinal fat (100%), localized mediastinal fluid collections (55%), free gas bubbles in the mediastinum (57.5%), mediastinal lymph nodes (35%), pericardial effusions (27.5%), pleural effusions (85%), lung infiltrates (35%), sternal dehiscence (40%), and pleuromediastinal fistula (2.5%). The sensitivity and specificity of CT in postoperative patients in the first 17 days was 100% and 33% respectively, and after day 17, 100% and 90%. In patients with ADNM sensitivity was 100% while in patients with suspected esophageal perforation sensitivity and specificity were 100%. CT is a highly sensitive technique for the detection of mediastinitis of various causes. For the postoperative patients there is clear time dependence for CT interpretation and accuracy. In patients with suspected ADNM, and traumatic esophageal perforation CT is highly specific early after clinical presentation.

Descending necrotising mediastinitis: two case reports and review of the literature

“…In contrast, DNM is a widespread infection of the neck and mediastinum along deep fascial planes that requires aggressive surgical debridement [1,9,10]. Several case reports and small case series have examined the optimal diagnostic modalities, antibiotic therapy, role of CT scanning and surgical approaches [3,9,[11][12][13][14][15][16][17][18]. Since delay in diagnosis is the primary factor contributing to mortality, the standard of therapy is a comprehensive approach including initial broad spectrum antibiotics, early CT scanning of the neck and thorax, early and wide debridement of cervical and thoracic infection, post-operative ICU monitoring, and surveillance CT scanning and re-operation, as required by clinical course [2,4].…”

“…CT evidence of mediastinitis includes localised mediastinal fluid collections or abscesses, gas bubbles in the mediastinal soft tissues, pleural or pericardial effusions, venous thrombosis and lymphadenopathy [6,22,25]. Diffuse mediastinitis may be seen, characterised by increased density of the mediastinal fat with resultant loss of definition of normal fat planes [17,25]. Mediastinal abscess is diagnosed based on the presence of a well-defined low-attenuation fluid collection with or without air, which may demonstrate rim enhancement following contrast administration.…”

Extension injury of the thoracic spine with rupture of the oesophagus and successful conservative therapy of concomitant mediastinitis

“…White et al [21] report that extraluminal air was the most useful CT finding which was present in 92% of their patients. Exarhos et al [8] investigated sensitivity and specificity of CT imaging in acute mediastinitis. In the subgroup of traumatic mediastinitis secondary to iatrogenic perforation, sensitivity and specificity of peri-oesophageal fluid collections and free air were both 100%, albeit there were only seven patients in this subgroup.…”

Cervical cellulitis and mediastinitis following esophageal perforation: A case report

“…CT-scan allows the visualization of FB and the identification of findings suggestive of esophageal perforation (esophageal wall thickening and laceration, peri-esophageal air and fluid). Intravenous administration of contrast material helps CT-scan localization of the exact extension of peri-esophageal infection in the neck, mediastinal, and pleuro-parenchymal spaces [8] . Its sensitivity can be increased with gastrografin ingestion.…”