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Medical emergency by Mediastinitis.

An inflammatory process that develops in the area of mediastinal tissue, called mediastinitis, is considered a life-threatening condition. Incorrect diagnosis and delayed treatment lead to the fact that mediastinitis during life is found in only 20% of patients. The mediastinum is an area (space) in the chest area (between the sternum and the thoracic spine, and delimited from below by the diaphragm), with which many organs are in contact: the trachea, bronchi, lungs, esophagus, pericardium, large blood vessels, including the descending aorta , vessels of the lymphatic system, branches of nerves and many other vital elements.

The space of the mediastinum is filled with loose fiber, and any inflammatory process of a serous or purulent nature from nearby tissues and organs spreads easily into the region of the mediastinum. Infection can spread from foci such as an abscess or phlegmon (for example, with odontogenic infection - from the oral cavity, with a pharyngeal abscess, phlegmon of the deep tissues of the neck), enter the mediastinum with penetrating wounds of the chest, with inflammation of the intrathoracic lymph nodes, deep lymphangitis. Mediastinitis may be the result of an operation performed on the mediastinal organs, trauma to the esophagus (chemical burn, rupture, damage), pneumonia, pulmonary tuberculosis, purulent pleurisy.

Mediastinitis is characterized by diffuse inflammation in the form of phlegmon, less often mediastinitis proceeds in the form of an abscess, which causes a severe course of the disease and septic phenomena. Mediastinitis can occur both acute and chronic inflammation of the tissues of the mediastinum. Acute mediastinitis is caused by infections, and chronic mediastinitis can be fibrous (that is, aseptic, without the participation of infectious agents, for example: rheumatic, idiopathic, with silicosis>, histoplasmosis, tuberculosis).

Signs of mediastinitis:

Feeling of heaviness in the chest area;
Pain in the chest and / or back and / or interscapular region (may worsen when the head is thrown back and / or swallowed);
Increasing pain when tapping on the sternum;
Swelling of tissues extends to the neck region, disrupts breathing and swallowing;
Thickening in the neck (in medicine is called "Stokes collar");
Puffiness in the face area;
Shortness of breath;
The position of the sick person is forced to half-sitting;
When the body is tilted, cyanosis of the lips, face, neck may occur (blue discoloration);
Veins of the neck and face expand, protrude against the background of the skin;
Chest asymmetry may occur;
Chills;
Profuse sweat (profuse sweating);
The temperature rises up to 40 in Celsius;
The pulse quickens;
Bradycardia develops;
Sometimes nosebleeds or hemoptysis occur.

Chronic mediastinitis can develop asymptomatically, but over time, signs of compression of the superior vena cava, pulmonary insufficiency, pulmonary edema, compression of other mediastinal organs, accompanied by attacks of suffocation, coughing, shortness of breath, changes in the sound of the voice, general weakness, and cardiovascular disorders.

A blood test shows leukocytosis with a shift of the formula to the left, increased ESR. The radiograph shows the expansion of the shadow of the mediastinum and neck. To clarify the diagnosis, tomography, pneumomediastinography, transesophageal ultrasound are performed (conventional ultrasound does not show violations due to the screening of the mediastinum by the bones of the sternum and spine).

Mediastinitis requires immediate treatment. In acute mediastinitis, an operation is performed to eliminate the source of infection, the mediastinal region and the pleural cavity are drained. Purulent - necrotic masses are removed through the installed catheters, then antibiotics are injected in the form of solutions and the cavity is washed with proteolytic enzymes.

In acute and chronic mediastinitis, systemic antibiotic therapy with broad-spectrum drugs is carried out in order to take into account all possible pathogens. With necrotic lesions of the lymph nodes, they are removed, with compression of the vessels, they are surgically decompression. If the cause of mediastinitis is tuberculosis, then specific anti-tuberculosis chemotherapy is performed. Mediastinitis treatment also suggests general detoxification measures, infusion therapy, symptomatic therapy, immunostimulating therapy.

The prognosis of the disease Mediastinitis directly depends on its timely diagnosis, which means that it makes sense to pay attention to the above symptoms as early as possible in order to avoid death. The lightning-fast current form of acute mediastinitis will lead to the death of the body in the first two days.