Inflammation of the mediastium - ie. the cavity within the thorax between the pleural cavities.

Causes

• Direct mediastinal access
  • Sternotomy / cardiothoracic surgery
  • Mediastinoscopy
  • Penetrating trauma
• Per trachea
  • Intubation / failed percutaneous tracheostomy
  • Bronchoscopy
• Per oesophagus
  • Boerhaave's
  • Iatrogenic oesophageal perforation
• Direct extension
  • Infection from lung, pleura

Organisms: anaerobic oral flora, respiratory flora - or multi-resistant strains if cardiothoracic surgery

Features (of general inflammation)

Pyrexia
Rigors
Surgical emphysema
Hamman's sign (crunching sound in systole)

Management

• Bloods: Inflammatory markers, FBC, CRP
• Imaging: CXR (enlarged mediastinum) + CT
• Treatment: Surgical drainage/debridement + Antibiotics