Les médiastinites aiguës en dehors d’un contexte de chirurgie cardiaque

Doddoli, Christophe; Trousse, Delphine; Avaro, J.-P.; D’Journo, Xavier-Benoît; Giudicelli, R; Fuentès, P.; Thomas, Philippe

doi:10.1016/j.pneumo.2009.12.013

Cited by 4 publications

(4 citation statements)

References 36 publications

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“…In case of any suspicion of retropharyngeal abscess, the doctor must prescribe empiric antibiotic therapy that subsequently adapted to the results of antibiogram to prevent it from moving towards infection with a worse prognosis: mediastinitis. Acute mediastinitis is an infectious disease, life-threatening in many cases (20-40% mortality), that extends from the oropharynx, cervical or esophageal region [ 8 ]. The extension of the cervical infection to the mediastinum is due to the continuity of cervico-mediastinal fascia [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…This infection of the mediastinum is extremely serious and suspected from clinical and radiological arguments. It must be confirmed by surgical exploration and the positive culture of per-operative microbiological samples [ 8 ]. The therapy is based on broad spectrum antibiotics, surgery, drainage and treatment of any organ failure.…”

Section: Discussionmentioning

confidence: 99%

“…A minimally invasive surgical approach may be recommended when the diagnosis is made early and the thoracic drainage is effective. The clinical, laboratory and CT monitoring may indicate a thoracotomy [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

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Retropharyngeal abscess revealing a migrant foreign body complicated by mediastinitis: a case report

Ziad¹,

Rochdi²,

Benhoummad³

et al. 2014

Pan Afr Med J

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Pharyngeal foreign bodies are quite common. Their diagnosis is usually easy. The risk of complications including retropharyngeal abscess and mediastinitis is rare and it depends mainly on the nature of the foreign body and the period of the therapeutic management. The occurrence of these complications darkens the prognosis of this affection usually benign. We report a 21 years old patient, without any significant history, admitted to the emergency for a high painful dysphagia and impaired general condition with fever 20 days after trauma in the posterior pharyngeal wall following a meal. The radiological assessment including cervico-thoracic CT scan had objectified the presence of a metallic foreign body in the retropharyngeal space associated with a retropharyngeal abscess and aggravated by a mediastinitis following the migration of the foreign body to the chest. Biological markers of infection were very increased. The therapeutic management consisted of a surgical drainage of the collections by a cervicotomy with removal of the foreign body. The outcome was favorable clinically and biologically. Pharyngeal foreign bodies are common and favorable when the diagnosis and extraction are made on time. The occurrence of complications, especially retropharyngeal abscess and mediastinitis is rare and burdened with a high morbidity and mortality.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Retropharyngeal abscess revealing a migrant foreign body complicated by mediastinitis: a case report

Ziad¹,

Rochdi²,

Benhoummad³

et al. 2014

Pan Afr Med J

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“…Tuberculosis, histoplasmosis, various fungal infections, malignancy, and sarcoidosis are the most common causes of chronic or slowly progressing mediastinitis. In a small number of cases, the cause was found to be a lymphatic blockage or an autoimmune illness [1,2]. However, chronic mediastinitis of tubercular origin with mediastinal emphysema is uncommon, and the majority of cases are caused by trauma.…”

Section: Introductionmentioning

confidence: 99%

Chronic Tubercular Mediastinitis: A Rare Case Presentation With Subcutaneous Emphysema

Choudhary,

Khedkar,

Aurangabadkar

et al. 2023

Cureus

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Tuberculosis, histoplasmosis, various fungal infections, malignancy, and sarcoidosis are the most common causes of chronic or slowly progressing mediastinitis. Chronic mediastinitis of tubercular origin with subcutaneous emphysema is exceptionally uncommon, and the majority of cases are caused by trauma. Here we report the case of a 35-year-old chronic alcoholic male who presented to the Outpatient Department (OPD) with complaints of cough, chest pain, loss of weight, and intermittent low-grade fever for three months with no significant past medical history or family history for any respiratory diseases. He was admitted and all routine investigations were performed, which were normal including his chest X-ray, except erythrocyte sedimentation rate (ESR) which was raised. The patient's high-resolution Computed Tomography (HRCT) of the thorax was done which showed multiple pleural-based nodular lesions with few showing central cavitary nodules along with ground glass appearance. It also showed two fistulous tracks of 3.4-millimeter diameter, arising from the trachea at the T1 -T2 vertebral level and at the carina which led to the presence of air in the subcutaneous plane extending from the neck up to visualized abdomen suggestive of chronic mediastinitis with tracheal fistula, along with subcutaneous emphysema. This fistula was confirmed by video bronchoscopy as well as three-dimensional (3D) virtual bronchoscopy. A biopsy was taken, which was positive for acid-fast bacilli (AFB) stain, polymerase chain reaction (PCR) for tuberculosis, and positive tuberculin skin test. The patient was started on anti-tubercular treatment and on a follow-up visit upon completion of the intensive phase, his HRCT and video bronchoscopy showed fibrosing scarring with fistula closure.

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Mediastinitis in the intensive care unit patient: a narrative review

Pastène

Cassir

Tankel

et al. 2020

Clinical Microbiology and Infection

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Background: Mediastinitis is a rare but severe infection, defined as an inflammation of the connective tissues and structures within the mediastinum. Due to its proximity to vital structures, mediastinitis represents a highly morbid pathological process associated with a high risk of mortality. In most cases mediastinitis requires treatment in the intensive care unit. Objectives: To highlight to the reader the clinical features of mediastinitis, to attempt to define each clinical scenario, to describe the responsible pathogens and finally to depict both the medical and surgical treatments. Sources: We performed a literature search of the PubMed and Cochrane libraries, limited for articles published between January 2003 and December 2018, reporting on acute mediastinitis. Content: The term covers different entities of different aetiologies including deep sternal wound infection related to sternotomy; oesophageal perforation or anastomosis leakage; and finally descending necrotizing mediastinitis, often secondary to oropharyngeal abscess. The responsible pathogens and therefore subsequent management depends on the underlying aetiology. Empirical antimicrobial therapy should cover the suspected microorganisms while surgery and supportive measures should aim to reduce the inoculum of pathogens by providing adequate drainage and debridement. Implications: Literature concerning mediastinitis in the intensive care unit is relatively scarce. We have collated the evidence and reviewed the different causes and treatment options of acute mediastinitis with a particular focus on microbiological epidemiology. Future research in larger cohorts is needed to better understand the treatment of this difficult disease.

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Les médiastinites aiguës en dehors d’un contexte de chirurgie cardiaque

Cited by 4 publications

References 36 publications

Retropharyngeal abscess revealing a migrant foreign body complicated by mediastinitis: a case report

Retropharyngeal abscess revealing a migrant foreign body complicated by mediastinitis: a case report

Chronic Tubercular Mediastinitis: A Rare Case Presentation With Subcutaneous Emphysema

Mediastinitis in the intensive care unit patient: a narrative review

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