Imaging in mediastinitis: a systematic review based on aetiology

Akman, Canan; Kantarcı, Fatih; Çetinkaya, Şenol

doi:10.1016/j.crad.2003.12.001

Cited by 88 publications

(58 citation statements)

References 52 publications

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“…Finally, the retropharyngeal pathway is located between the esophagus and spine and is also called the "prevertebral" or "retrovisceral" space. 1,10 This interfascial space starts at the C6 level of the spine and continues as far as the T1 level (where the alar fascia joins the inferior constrictor muscles of the pharynx); from that point onwards, the so-called "danger space" starts. This name is given because this space is patent from the skull base to the diaphragm, thereby allowing the spread of infection to the mediastinum.…”

Section: Discussionmentioning

confidence: 99%

“…Chills, high-fever, tachycardia, dyspnea and non-productive cough are the main symptoms and the most common ones associated with mediastinitis. 1,8 When the upper mediastinum is involved, retrosternal pain that radiates upwards into the neck may be present. On the other hand, when the posterior compartment of the inferior mediastinum is affected, pain originates between the scapulae and radiates around the chest.…”

Section: Clinical Manifestations Clinical Manifestationsmentioning

confidence: 99%

“…1,2 It can be secondary to infectious or non-infectious causes and, depending on the etiology, it can be acute or chronic. In its acute form, it is a life-threatening condition if not diagnosed early or if treated inadequately.…”

Section: Introductionmentioning

confidence: 99%

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Descending mediastinitis: a review

2006

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CONCLUSION:Since DM is a lethal condition if not promptly treated, it must always be considered to represent an emergency situation. deep neck into three major fascial pathways by which oropharyngeal infections can spread towards the mediastinum (Table 1). The three layers are the pretracheal or superfi cial, visceral and prevertebral layers. In turn, there are three main fascial pathways. The fi rst of these is the pretracheal pathway, which is anterior to the trachea and ends in the anterior mediastinum at the level of the carina. This space is limited superiorly by the thyroid cartilage and is the most superfi cial of these spaces. The second is the lateropharyngeal pathway, which extends from the base of the skull to the aortic arch and drains into the middle mediastinum. This is formed by fusion of the major layers of the cervical fascia, and it has communication with all the cervicofascial spaces. It is also called the "perivascular space", because it is surrounded by the carotid sheath and thus contains the carotid artery, internal jugular vein and vagus nerve. Finally, the retropharyngeal pathway is located between the esophagus and spine and is also called the "prevertebral" or "retrovisceral" space. 1,10 This interfascial space starts at the C6 level of the spine and continues as far as the T1 level (where the alar fascia joins the inferior constrictor muscles of the pharynx); from that point onwards, the so-called "danger space" starts. This name is given because this space is patent from the skull base to the diaphragm, thereby allowing the spread of infection to the mediastinum. When infection reaches this level, the prognosis is usually poor.About 70% of the cases of DM occur through the retropharyngeal pathway 9-11 and 8% occur via the pretracheal route. 9 The latter is more common in infections originating from thyroid gland. 9 The remainder of the cases occur via perivascular spreading and, in these cases, the process is frequently complicated with arterial hemorrhage. In general, pharyngeal abscesses spread into the retropharyngeal space to reach the posterior mediastinum, whereas submental and submaxillary abscesses spread towards the anterior mediastinum.12 It is important to remember that transdiaphragmatic spread via either the esophageal hiatus or the vena cava foramen may also occur, especially in immunocompromised patients. 2Epidemiology and Epidemiology and classifi cation classifi cation DM mainly affects young adults. The median age is 36 years and 86% of the patients are men. 13 Odontogenic infection is the most common cause of descending mediastinitis, 8,14 especially when the second and third lower molars are involved. It accounts for 40-60% of the cases. The second most common cause is retropharyngeal abscess (14%). Peritonsillar abscesses makes up 11% of the etiologies. Either retropharyngeal or peritonsillar abscess may cause violation of the lateropharyngeal spaces and downward spread of the infection to the mediastinum.12 Less common causes include cervical lymphadenitis (7%)...

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Section: Discussionmentioning

confidence: 99%

Section: Clinical Manifestations Clinical Manifestationsmentioning

confidence: 99%

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Descending mediastinitis: a review

2006

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“…Those patients often present with vomiting, chest pain and subcutaneous emphysema, and may have fever and hypotension. CT findings often include esophageal wall thickening, fluid collections in the adjacent mediastinal or lower cervical areas, extraluminal air and extravasation of ingested contrast material into the mediastinum or pleural space (2). Esophageal perforation is a contraindication for TEE and, if it is case rePort ©2009 Pulsus Group Inc. All rights reserved Staphylococcus aureus is a relatively common pathogen causing pneumonia in the community, hospital ward and intensive care unit.…”

Section: Discussionmentioning

confidence: 99%

Para-aortic arch abscess secondary to Staphylococcus aureus pneumonia

Koo

Sun²,

Whitlock³

et al. 2009

Canadian Journal of Cardiology

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“…It is usually located in the left lower hemithorax and receives its blood supply from one or more systemic arteries (2). Bronchogenic cysts originate from an abnormal budding of the tracheobronchial tree and are typically solitary cysts lined with either squamous or ciliated columnar epithelium, which is similar to bronchi (3).…”

Section: Introductionmentioning

confidence: 99%

Bronchopulmonary foregut malformation presenting as extralobar pulmonary sequestration associated with a bronchogenic cyst: an unusual clinical and radiological feature in an adolescent patient

Choo¹,

Hwang²,

Lee³

et al. 2017

J. Thorac. Dis.

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We present a case of symptomatic complex bronchopulmonary foregut malformation (BPFM), including extralobar pulmonary sequestration and a bronchogenic cyst, in the left anterior mediastinum of a 15-year-old boy. Preoperative computed tomography showed a cystic mass with heterogeneous enhancement of adjacent soft tissue components and pleural effusion. We suggested the infected bronchogenic cyst as the first impression. However, pathological examination after surgical resection revealed extralobar pulmonary sequestration and a bronchogenic cyst with unusual manifestation, which was located in the left upper hemithorax and supplied by the pulmonary artery. In patients presenting with a cystic mass with features of inflammation or infection and collateral vasculature, the possibility of a complex bronchopulmonary foregut malformation should be considered in the differential diagnosis. J Thorac Dis 2017;9(7):E632-E635 jtd.amegroups.com suggesting an extrapulmonary origin. The mass contained a non-enhanced homogenous low-attenuated fluid component ( Figure 1A). There was a scanty amount of pleural fluid in the left hemithorax, suggesting perforation of the cystic mass ( Figure 1A). A small artery originating from the left pulmonary artery and entering the medial side of the cystic mass was visualized ( Figure 1B). We therefore suggested the presence of a complicated cystic mass, such as a bronchogenic cyst or dermoid cyst, with infection.The patient underwent thoracoscopic surgical intervention for lesion resection. During surgery, we found a supernumerary lobe of the left lung, with a vascular hilum, between the upper and lower lobes. This lobe consisted of cystic and solid components with hilar vasculature without perforation. The cystic component, which contained thick mucus-like material, included the hilum, and the solid component, which turned out to be composed of lung tissue, was an inclusion of the cystic mass ( Figure 1C). A small feeding vessel originating from the hilum was identified and divided with an endoscopic stapler. Gross pathological examination showed a unilocular cystic mass within the inflamed sequestrated lung ( Figure 1D) with a wall showing fibrotic change. Microscopically, a bronchial DiscussionBPFMs have been described by numerous classifications and terminologies incorporating a common origin and association. These include congenital anomalies associated with the development of the foregut (bronchogenic cyst, esophageal/neurenteric cyst, tracheoesophageal fistula/ diverticula/stenosis), pulmonary [pulmonary agenesis/ hypoplasia, congenital lobar emphysema, congenital pulmonary airway malformation (CPAM)], airway (tracheal/ bronchial atresia, tracheal bronchus), and vascular (pulmonary sling, alveolar capillary dysplasia) components (1,4,5).Bronchogenic cysts generally demonstrate an enhanced capsular wall and a homogenous consistency on enhanced CT because they have a bronchial epithelial lining and are filled with mucus (6). In the case of complicated bronchogenic cysts, a th...

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Imaging in mediastinitis: a systematic review based on aetiology

Cited by 88 publications

References 52 publications

Descending mediastinitis: a review

Descending mediastinitis: a review

Para-aortic arch abscess secondary to Staphylococcus aureus pneumonia

Bronchopulmonary foregut malformation presenting as extralobar pulmonary sequestration associated with a bronchogenic cyst: an unusual clinical and radiological feature in an adolescent patient

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