acute mediastinitis
Introduction
Introduction to acute mediastinal inflammation Mediastinal inflammation refers to bacterial infections in the mediastinum, divided into acute and chronic. Acute mediastinal inflammation often forms abscesses, the condition is serious, chronic mediastinal inflammation is mostly granuloma-like, often caused by primary tuberculosis or histoplasmosis, slow onset, often asymptomatic, found in X-ray examination, a few The patient may also have symptoms and signs due to obstruction or compression caused by the lesion. basic knowledge The proportion of illness: 0.0003% Susceptible people: no special people Mode of infection: non-infectious Complications: empyema, pneumothorax
Cause
Acute mediastinal inflammation
(1) Causes of the disease
Acute mediastinal inflammation refers to trauma, acute mediastinal connective tissue purulent inflammation caused by surgery and infection. It is rare in clinical practice, mostly secondary. Common causes are penetrating chest trauma, esophageal or tracheal rupture, and ingestion of foreign body. Perforation of esophagus, anastomotic leakage after esophageal surgery, traumatic perforation during esophagoscopy and external perforation of esophageal cancer, etc., may also be spontaneous, often occurs during vomiting, occasionally adjacent tissues such as the esophageal posterior cavity, lung, pleural cavity , caused by the direct spread of infections such as lymph nodes and pericardium.
(two) pathogenesis
The mediastinum has fat, rich lymph and loose connective tissue. After infection, it is easy to spread. The mediastinum caused by perforation of the esophagus often has pleural effusion. It is more common on the left side and rapidly develops into empyema. Air into the mediastinum may be complicated by mediastinal emphysema or pneumothorax, and the mediastinal abscess may also directly break into the esophagus, bronchus or pleural cavity.
Prevention
Acute mediastinal inflammation prevention
1. A large number of antibiotics control infection, beware of dysbacteriosis. According to the pathogen and drug susceptibility test, an effective amount of antibiotic is selected, and intravenous administration is preferred, and the therapeutic effect is observed and the drug and dosage are adjusted in time.
2. Support therapy, give high protein, high calorie, high vitamin diet, encourage more drinking water.
3. Pervasive chest trauma should emphasize timely diagnosis, active rescue, and prevention of acute mediastinal inflammation.
Complication
Acute mediastinal complications Complications
Can be complicated by empyema and pus.
Symptom
Acute mediastinal inflammation symptoms Common symptoms High fever chills dyspnea Difficulty swallowing difficulty Bleeding sternal pain Mediastinal voiced circles expand subcutaneous emphysema tachycardia shock
Onset, there are high fever, chills and other toxic symptoms, often accompanied by dysphagia, pain in the back of the chest, and radiation to the neck or cause earache. If the abscess forms a compressed trachea, it can produce high-pitched cough, difficulty breathing, tachycardia and Bun, severe shock can be life-threatening, physical examination of the sternum is tender, mediastinal voiced circles widened, neck swelling and paralysis and subcutaneous emphysema.
Occurred in trauma, acute mediastinal inflammation after surgery, the diagnosis is not difficult, there are swallowing foreign bodies, neck infections, sepsis and other medical history can also think of the possibility of this disease.
Examine
Acute mediastinal examination
The peripheral blood leukocytes and neutrophils increased significantly.
The X-ray showed widening of the mediastinal shadows on both sides. The mediastinum was obvious. The inflammation of the surrounding pleura caused the contours on both sides to be blurred. The posterior sternal sternal density increased. The outline of the trachea and aortic arch was blurred, forming an abscess. One side or both sides see prominent abscess shadow, trachea, esophageal pressure displacement, mediastinal emphysema, abscess and fluid level, pleural fluid pneumothorax, etc., esophageal lipiodol or organic iodine angiography can confirm esophageal perforation The site, esophageal bronchospasm or esophageal pleural palsy.
Diagnosis
Diagnosis and diagnosis of acute mediastinum
In addition to the medical history, the diagnosis is mainly based on clinical manifestations, but due to a part of the whole process of mediastinal inflammation, and simple mediastinal inflammation on the X-ray, except for the possibility of mediastinal shadow widening, there is no special manifestation of mediastinal emphysema, so clinical What is seen above is a localized mediastinal abscess, or the posterior mediastinum has a gas-liquid surface on the lateral chest radiograph, pus and pneumothorax, and sometimes it is not easy to diagnose. The X-ray examination is important after the anterior and lateral chest radiographs. Generally, bedside photography is not clear due to the relationship between the conditions of the projection. For the convenience of diagnosis, it is best to take the chest chest and the lateral chest radiograph after the semi-sitting position. If the esophagus or tracheal rupture is suspected, 40% sterile iodized oil angiography can be avoided. Use tincture to avoid long-term retention and stimulate the tissue.
