Mediastinitis: causes, management and outcomes

The term mediastinitis refers to inflammation of the tissues located in the mediastinal space. Many aetiological factors contribute to acute and chronic infection of the mediastinum. Although long recognised as a complication of certain infectious diseases, most cases of acute mediastinitis follow oesophageal perforation and open chest surgery. Less common causes include tracheal, bronchial perforation or direct infection from adjacent tissues. Acute mediastinitis is a life-threatening condition that is almost always a complication of other clinical problems. Chronic fibrosing mediastinitis is a slow deposition of thick fibrous tissue encasing any of the mediastinal structures, most commonly secondary to tuberculosis, histoplasmosis, other fungal infections, cancer or sarcoidosis. Descending necrotising mediastinitis is the most dreaded and lethal form of mediastinitis originating from oropharyngeal infection that extends through the deep neck planes to the mediastinum. The clinical spectrum ranges from the subacute to the fulminate critically ill patient, and therefore early diagnosis and prompt aggressive medical and surgical treatment are required to prevent death.