Use of Computed Tomography to Assess Mediastinal Complications after Median Sternotomy

Kay, H. D.; Goodman, Lawrence R.; Teplick, Steven K.; Mundth, Eldred D.

doi:10.1016/s0003-4975(10)60283-4

Cited by 42 publications

(23 citation statements)

References 14 publications

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“…Persistence of these findings after this period, however, is highly indicative of mediastinitis. Our findings suggest a definite time factor with a higher true positive yield of CT after postoperative day 17, a fact which is in good agreement with previous reports [5,10]. Correlation with other clinical and laboratory results further increases diagnostic yield.…”

Section: Discussionsupporting

confidence: 92%

“…4), and may not return to normal for as long as 2 months after surgery [5][6][7][8]. Increased attenuation of mediastinal fat was recorded in all of our patients, but does not seem to be a specific finding in the postoperative group of patients during the first 3 weeks [6,9,10]. Gas bubbles in the mediastinum with or without associated fluid collections Fig.…”

Section: Discussionmentioning

confidence: 80%

“…Diagnosis was confirmed by surgery are found in up to half of the reported mediastinitis series [1,[5][6][7]. However, gas bubbles and mediastinal fluid collections may be normal findings for at least 21 days after surgery, and are observed in more than 75% of asymptomatic patients [10]. These difficulties have been considered a significant drawback of CT and have led some authors to infer that CT has limited usefulness in the diagnosis of postoperative complications [11][12][13].…”

Section: Discussionmentioning

confidence: 99%

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Acute mediastinitis: spectrum of computed tomography findings

Exarhos

Malagari²,

Tsatalou

et al. 2004

Eur Radiol

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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.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Acute mediastinitis: spectrum of computed tomography findings

Exarhos

Malagari²,

Tsatalou

et al. 2004

Eur Radiol

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“…A variety of symptomatic problems can lead to CT examination of the sternum, including a sternal click, excessive incisional pain,sterile or purulent wound drainage, and sternal instability [4]. (Fig.…”

Section: Sternal Complicationsmentioning

confidence: 99%

“…Eventually, frank bone destruction, severe demineralization,and dehis- cence are universal in sternal osteomyelitis. CT can show subtle erosions, periostealnew bone formation, sharply marginated sclerosis,and adjacent soft-tissueswelling [4] (Fig. 15).…”

Section: Sternal Complicationsmentioning

confidence: 99%

CT evaluation of poststernotomy complications.

Templeton

Fishman

1992

American Journal of Roentgenology

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Poststernotomy Infections Presenting as Deep Neck Abscess

Simpson

Peters²

1988

Archives of Otolaryngology - Head and Neck Surgery

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\s=b\A review of the world literature has failed to reveal any published reports of poststernotomy mediastinitis presenting as a deep neck infection. This article presents two such cases. Since the fascial layers of the mediastinum are a direct continuation of the cervical fascia, a number of potential pathways between the neck and mediastinum exist. Descending infection from the neck into the mediastinum is well documented. The reverse situation, an ascending infection from the mediastinum into the neck, is not described despite the potential natural pathways available for spread of infection. Our proposed mechanism for these two cases is that a surgically created pathway from the mediastinum to the lower neck allows for mediastinitis to point in the intercommunicating fascial spaces of the neck. Recognition of this clinical presentation will allow the surgeon to use prompt intervention for such a serious complication.(Arch Otolaryngol Head Neck Surg 1988;114:909-912) Otol aryngol ogi sts and thoracic sur¬ geons are aware of the potential for the development of mediastinitis secondary to deep neck abscess. The cervical fascia and the spaces between its layers communicate directly or indirectly with the fascia of the medi¬ astinum, providing natural pathways for the spread of infection from the neck to the chest. We should, there¬ fore, theoretically see some cases of neck infection resulting from medias-tinitis. However, there are no pub¬ lished reports of this clinical picture.This article presents two cases of poststernotomy mediastinitis that resulted in deep neck infection. More¬ over, the neck abscess was the initial sign, and the only clue that a more life-threatening infectious process was ongoing.Although infections can spread along natural pathways, we propose that a pathway from the mediastinum to the neck was created surgically, allowing for the sternotomy infection to point in the lower neck in the fasciai spaces that had been entered.Though obviousy rare, knowing this scenario of silent mediastinitis will allow the surgeon to take early and aggressive surgical measures that could significantly decrease the mor¬ bidity and mortality associated with such a serious complication. REPORT OF CASESCase 1.-A 66-year-old man with a fiveyear history of syncopal episodes was eval¬ uated at the University of Alabama at Birmingham. Cardiac catheterization showed calcific aortic stenosis. On July 16, 1985, a median sternotomy incision for aortic valve replacement was performed. Cephapirin sodium therapy was used for four days postoperatively. On the fifth postoperative day, the patient had lowgrade fever, along with an enlarging tender left-sided neck mass. Physical examination revealed induration, warmth, and exquisite tenderness of the entire left sternocleidomastoid muscle. Also noted were erosions in the subglottic area bilat¬ erally. A chest roentgenogram was normal. Computed tomographic scan of the neck revealed an abscess within the belly of the sternocleidomastoid muscle as demon¬ strated in Fig 1. Th...

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Use of Computed Tomography to Assess Mediastinal Complications after Median Sternotomy

Cited by 42 publications

References 14 publications

Acute mediastinitis: spectrum of computed tomography findings

Acute mediastinitis: spectrum of computed tomography findings

CT evaluation of poststernotomy complications.

Poststernotomy Infections Presenting as Deep Neck Abscess

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