Mediastinitis is inflammation

Inflammation

Inflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process...

 of the tissues in the mid-chest, or mediastinum

Mediastinum

The mediastinum is a non-delineated group of structures in the thorax, surrounded by loose connective tissue. It is the central compartment of the thoracic cavity...

. It can be either acute or chronic

Chronic (medicine)

A chronic disease is a disease or other human health condition that is persistent or long-lasting in nature. The term chronic is usually applied when the course of the disease lasts for more than three months. Common chronic diseases include asthma, cancer, diabetes and HIV/AIDS.In medicine, the...

.

Acute mediastinitis is usually bacterial and due to rupture of organs in the mediastinum. As the infection can progress rapidly, this is considered a serious condition. Chronic sclerosing

Sclerosis (medicine)

In medicine, sclerosis refers to the stiffening of a structure, usually caused by a replacement of the normal organ-specific tissue with connective tissue.Types include:...

 (or fibrosing

Fibrosis

Fibrosis is the formation of excess fibrous connective tissue in an organ or tissue in a reparative or reactive process. This is as opposed to formation of fibrous tissue as a normal constituent of an organ or tissue...

) mediastinitis, while potentially serious, is caused by a long-standing inflammation of the mediastinum, leading to growth of acellular collagen and fibrous tissue within the chest and around the central vessels and airways. It has a different cause, treatment, and prognosis than acute infectious mediastinitis.

Acute

Before the development of modern cardiovascular surgery, cases of acute mediastinitis usually arose from either perforation

Perforation

A perforation is a small hole in a thin material or web. There is usually more than one perforation in an organized fashion, where all of the holes are called a perforation...

 of the esophagus

Esophagus

The esophagus is an organ in vertebrates which consists of a muscular tube through which food passes from the pharynx to the stomach. During swallowing, food passes from the mouth through the pharynx into the esophagus and travels via peristalsis to the stomach...

 or from contiguous spread of odontogenic

Dental caries

Dental caries, also known as tooth decay or a cavity, is an irreversible infection usually bacterial in origin that causes demineralization of the hard tissues and destruction of the organic matter of the tooth, usually by production of acid by hydrolysis of the food debris accumulated on the...

 or retropharyngeal

Retropharyngeal space

The retropharyngeal space is a space bounded by the buccopharyngeal fascia anteriorly and the alar fascia posteriorly.It includes the retropharyngeal lymph nodes....

 infections. However, in modern practice, most cases of acute mediastinitis result from complications

Complication (medicine)

Complication, in medicine, is an unfavorable evolution of a disease, a health condition or a medical treatment. The disease can become worse in its severity or show a higher number of signs, symptoms or new pathological changes, become widespread throughout the body or affect other organ systems. A...

 of cardiovascular or endoscopic surgical procedures.

Treatment usually involves aggressive intravenous antibiotic therapy and hydration. If discrete fluid collections (such as abscesses) or grossly infected tissue have formed, they may have to be surgically drained or debrided.

Chronic

Chronic mediastinitis is usually a radiologic diagnosis manifested by diffuse fibrosis of the soft tissues of the mediastinum. This is sometimes the consequence of prior granulomatous disease, most commonly histoplasmosis

Histoplasmosis

Histoplasmosis is a disease caused by the fungus Histoplasma capsulatum. Symptoms of this infection vary greatly, but the disease primarily affects the lungs...

. Other identifiable causes include tuberculosis

Tuberculosis

Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...

 and radiation

Radiation

In physics, radiation is a process in which energetic particles or energetic waves travel through a medium or space. There are two distinct types of radiation; ionizing and non-ionizing...

 therapy. Fibrosing mediastinitis most frequently causes problems by constricting blood vessels or airways in the mediastinum. This may result in such complications as superior vena cava syndrome

Superior vena cava syndrome

Superior vena cava syndrome , or superior vena cava obstruction , is usually the result of the direct obstruction of the superior vena cava by malignancies such as compression of the vessel wall by right upper lobe tumors or thymoma and/or mediastinal lymphadenopathy. The most common malignancies...

 or pulmonary edema

Pulmonary edema

Pulmonary edema , or oedema , is fluid accumulation in the air spaces and parenchyma of the lungs. It leads to impaired gas exchange and may cause respiratory failure...

 from compression of pulmonary veins.

Treatment for chronic fibrosing mediastinitis is somewhat controversial, and may include steroids or surgical decompression of affected vessels.

External links

• Fibrosing Mediastinitis
• Fibrosing Mediastinitis Jason's Site
• Tami Jo's Site on FM
• Mediastinal Germ Cell Tumors