Acute mediastinitis. Lection for students of 5 course

Август 20, 2022

Главная
Английский язык
Acute mediastinitis. Lection for students of 5 course

Содержание

2. Acute mediastinitis is most often the result of bacterial infection of the mediastinum. Mediastinitis may be
3. Causes acute mediastinitis The most common cause is oesophageal perforation. Esophageal perforation may complicate esophagoscopy or
4. Causes acute mediastinitis The other causes that are much less common include: postoperative infection, particularly following
5. Symptoms patients present with chills chest pain high fever tachycardia
6. Diagnostic Chest radiography may show mediastinalChest radiography may show mediastinal widening and findings of mediastinal abscess
7. Diagnostic CT scan in a patient with a mediastinal fluid collection located within the retrosternal space.
8. Complications of mediastinitis Abscess formation Empyema Esophagocutaneous fistulas Sternal osteomyelitis Pericardial tamponade
9. Complications of mediastinitis Common complications of mediastinitis result from extension of the infectious process into contiguous
10. Complications of mediastinitis Pericardial effusion and subsequent tamponade can result from direct extension of the infectious
11. Complications of mediastinitis diagnostic Echocardiography demonstrated a moderate to large circumferential pericardial effusion. Pericardiocentesis was subsequently
12. Complications of mediastinitis diagnostic Laboratory analysis of the recovered fluid revealed pericardial and pleural exudates, with
13. Treatment open surgical drainage and débridement are necessary to prevent serious morbidity and mortality. The importance
14. Treatment Percutaneous catheter drainage has been used in less urgent clinical settings, often as a temporizing
15. Treatment The patient underwent an open thoracotomy with drainage and removal of right paratracheal and subcarinal
17. Скачать презентацию

Слайд 2

Acute mediastinitis
is most often the result of bacterial infection
of the

mediastinum. Mediastinitis may be associated with empyema and subphrenic abscess.

Слайд 3

Causes acute mediastinitis
The most common cause is oesophageal perforation.
Esophageal perforation

may complicate esophagoscopy or insertion of a Sengstaken-Blakemore or Minnesota tube (for esophageal variceal bleeding). It may occur with vomiting (Boerhaave's syndrome). Patients with esophageal perforation are generally acutely ill, with severe chest pain and dyspnea due to mediastinal infection and inflammation

Слайд 4

Causes acute mediastinitis
The other causes that are much less common include:

postoperative infection, particularly following median sternotomy;
leakage from the oesophagusleakage from the oesophagus into the mediastinum through a necrotic neoplasm;
traumatic rupture tracheobronchial tree;
extension of infection from adjacent anatomical regions, particularly the nasopharynx or teeth, and occasionally from adjacent structures such as the lungs, pleura, pericardium and mediastinalextension of infection from adjacent anatomical regions, particularly the nasopharynx or teeth, and occasionally from adjacent structures such as the lungs, pleura, pericardium and mediastinal lymph nodes.

Слайд 5

Symptoms
patients present with chills
chest pain
high fever
tachycardia

Слайд 6

Diagnostic
Chest radiography may show mediastinalChest radiography may show mediastinal widening and

findings of mediastinal abscess including gas bubbles or airfluid level.
PneumothoraxPneumothorax and pneumomediastinumPneumothorax and pneumomediastinum are frequently associated in case of oesophageal perforation.
CTCT is more sensitive than chest radiography for detecting the presence and extent of mediastinalCT is more sensitive than chest radiography for detecting the presence and extent of mediastinal fluid collections and the presence of extraluminal gas (Fig.1).

Слайд 7

Diagnostic
CT scan in a patient with a mediastinal fluid collection located

within the retrosternal space. The collection is circumscribed by a rim of contrast enhancement and contains a small gas bubble (arrow). This appearance corresponded to a poststernotomy mediastinal abscess

Слайд 8

Complications of mediastinitis
Abscess formation
Empyema
Esophagocutaneous fistulas
Sternal osteomyelitis
Pericardial tamponade

Слайд 9

Complications of mediastinitis
Common complications of mediastinitis result from extension of the

infectious process into contiguous structures and spaces.
Thus, abscess formation and empyema are relatively common complications of acute mediastinitis of any cause. Late complications of acute mediastinitis resulting from esophageal perforation include esophagocutaneous, esophagopleural, and esophagobronchial fistulas.
Sternal osteomyelitis is a common complication of mediastinitis after a cardiothoracic operation but is an infrequent complication of nonsurgical causes of mediastinitis; therefore, it would be unlikely to occur in this patient.

Слайд 10

Complications of mediastinitis
Pericardial effusion and subsequent tamponade can result from direct

extension of the infectious process into the pericardial space but can also occur as a secondary inflammatory response to infection. The incidences of pericardial effusion, abscess, and empyema formation all increase if treatment is delayed.
Soon after admission of this patient, clinical signs of tamponade developed, including a pulsus paradoxus, worsening dyspnea, and increased jugular venous pressure.

Слайд 11

Complications of mediastinitis diagnostic
Echocardiography demonstrated a moderate to large circumferential pericardial

effusion.
Pericardiocentesis was subsequently performed; 500 mL of serous fluid was drained, and a percutaneous pigtail catheter was placed for continued drainage.
The patient also underwent thoracentesis for diagnostic and therapeutic purposes.

Слайд 12

Complications of mediastinitis diagnostic
Laboratory analysis of the recovered fluid revealed pericardial and

pleural exudates, with total nucleated cell counts of 2.55×109/L (91% neutrophils) and 6.9×109/L (81% neutrophils), respectively. Gram stain, fungal and acid-fast stains, and cultures of the recovered fluid were negative.

Слайд 13

Treatment
open surgical drainage and débridement are necessary to prevent serious morbidity

and mortality. The importance of early diagnosis and surgical management has been clearly documented. Delay in treatment can result in extensive local advancement within as short a time span as 12 hours and is associated with a steep increase in mortality.
The antibiotic treatment in this patient was sufficiently broad to cover organisms commonly implicated in acute mediastinitis but was unable to curtail the rapid progression of the infection.

Слайд 14

Treatment
Percutaneous catheter drainage has been used in less urgent clinical settings,

often as a temporizing measure, but open surgical drainage remains the standard of therapy. Although the initial Gastrografin swallow study failed to document an esophageal perforation, the working hypothesis was that a small perforation during the patient’s recent EGD led to the patient’s subsequent mediastinal infection. Because of the deteriorating clinical situation, observation or repeated attempts to document an esophageal perforation would be of no value.

Слайд 15

Treatment
The patient underwent an open thoracotomy with drainage and removal of

right paratracheal and subcarinal abscesses, aggressive irrigation, and pericardiotomy. Bronchoscopy and rigid esophagoscopy done at the initiation of the procedure demonstrated no visible fistulas or other abnormalities. Thoracotomy disclosed a large mediastinal mass superior to the azygos vein and a second large mass in the subcarinal space.

Acute mediastinitis. Lection for students of 5 course

Содержание

Acute mediastinitis is most often the result of bacterial infection of the

Causes acute mediastinitis The most common cause is oesophageal perforation. Esophageal perforation

Causes acute mediastinitisThe other causes that are much less common include:

Symptomspatients present with chills chest pain high fever tachycardia

DiagnosticChest radiography may show mediastinalChest radiography may show mediastinal widening and

DiagnosticCT scan in a patient with a mediastinal fluid collection located

Complications of mediastinitisAbscess formationEmpyemaEsophagocutaneous fistulasSternal osteomyelitisPericardial tamponade

Complications of mediastinitis Common complications of mediastinitis result from extension of the

Complications of mediastinitisPericardial effusion and subsequent tamponade can result from direct

Complications of mediastinitis diagnostic Echocardiography demonstrated a moderate to large circumferential pericardial

Complications of mediastinitis diagnosticLaboratory analysis of the recovered fluid revealed pericardial and

Treatmentopen surgical drainage and débridement are necessary to prevent serious morbidity

TreatmentPercutaneous catheter drainage has been used in less urgent clinical settings,

TreatmentThe patient underwent an open thoracotomy with drainage and removal of

Похожие презентации