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Mediastinitis is swelling and irritation (inflammation) of the area between the lungs (mediastinum). This area contains the heart, large blood vessels, windpipe (trachea), esophagus, thymus gland, lymph nodes, and connective tissues.

Mediastinitis may occur suddenly (acute) or may develop slowly and get worse over time (chronic). Most cases occur in patients who have had open chest surgery. Less than 5 percent of patients develop mediastinitis after having chest surgery.

Patients may have a tear in their esophagus that causes mediastinitis. Causes of the tear include:

• A procedure such as endoscopy
• Forceful or constant vomiting
• Trauma

Other causes of mediastinitis include:

• Cancer
• Histoplasmosis
• Radiation
• Sarcoidosis
• Tuberculosis

Risk factors include:

• Problems in the upper gastrointestinal tract
• Recent chest surgery or endoscopy
• Weak immune system

• Chest pain
• Chills
• Coughing up blood
• Fever
• Malaise
• Shortness of breath

Signs of mediastinitis in patients who have had recent surgery include:

• Chest wall tenderness
• Wound drainage
• Unstable chest wall

Tests include:

• Chest CT scan or MRI scan
• Chest x-ray

Your health care provider may insert a needle into the area of inflammation and remove a sample to send for gram stain and culture to find the source of any infection.

You may receive antibiotics if you have an infection.

You may need surgery to remove the area of inflammation if the blood vessels, windpipe, or esophagus is blocked.

How well a person does depends on the cause of the mediastinitis.

Mediastinitis after open chest surgery is very serious. There is a significant risk of dying from the condition.

Complications include the following:

• Spread of the infection to the:
  • Bloodstream
  • Blood vessels
  • Bones
  • Heart
  • Lungs
• Scarring

Scarring can be severe, especially when it is caused by chronic mediastinitis. Scarring can interfere with heart or lung function.

Contact your health care provider if you have had open chest surgery and develop:

• Chest pain
• Chills
• Drainage from the wound
• Fever
• Shortness of breath

If you have tuberculosis, histoplasmosis, or sarcoidosis and develop any of these symptoms, contact your health care provider right away.

The only way to prevent mediastinosis related to chest surgery is to keep surgical wounds clean and dry after surgery.

Treating tuberculosis, sarcoidosis, or other conditions associated with mediastinitis may prevent this complication.

Chest infection

Park DR, Vallières E. Pneumomediastinum and mediastinitis. In: Mason RJ, Murray J, Broaddus VC, Nadel J, eds. Textbook of Respiratory Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2005: chap 72.

Updated by: Linda Vorvick, MD, Seattle Site Coordinator, Lecturer, Pathophysiology, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; and Jatin M. Vyas, PhD, MD, Instructor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.