Mediastinitis usually results from a tear in the esophagus or chest surgery.
People have severe chest pain, shortness of breath, and fever.
A chest x-ray and usually computed tomography (CT) are needed for diagnosis.
Treatment is with antibiotics and sometimes surgery.
(See also Overview of Pleural and Mediastinal Disorders Overview of Pleural and Mediastinal Disorders The pleura is a thin, transparent, two-layered membrane that covers the lungs and also lines the inside of the chest wall. The layer that covers the lungs lies in close contact with the layer... read more .)
Mediastinitis may be
Acute, occurring suddenly
Chronic, developing slowly as a result of long-term irritation or an infection that takes a long time to resolve
Mediastinitis most often results from an infection. The two most common causes of infection are
A tear in the esophagus
Chest surgery (a procedure called median sternotomy)
The esophagus may be torn accidentally during a procedure such as endoscopy, by forceful vomiting (Boerhaave syndrome), or by an injury to the chest. Sometimes a tear (hole) in the esophagus results from swallowing a caustic substance such as lye or certain button batteries.
Median sternotomy involves an incision made down the length of the breastbone (sternum), splitting it in two. Median sternotomy is used so doctors can gain access to the chest for procedures such as heart transplantation, heart valve surgery, or coronary artery bypass surgery.
Less common causes include tuberculosis Tuberculosis (TB) Tuberculosis is a chronic contagious infection caused by the airborne bacteria Mycobacterium tuberculosis. It usually affects the lungs, but almost any organ can be involved. Tuberculosis... read more 
, histoplasmosis Histoplasmosis Histoplasmosis is an infection caused by the fungus Histoplasma capsulatum. It occurs mainly in the lungs but can sometimes spread throughout the body. Histoplasmosis is acquired by inhaling... read more 
(a fungal infection), sarcoidosis Sarcoidosis Sarcoidosis is a disease in which abnormal collections of inflammatory cells (granulomas) form in many organs of the body. Sarcoidosis usually develops in people aged 20 to 40 years, most often... read more 
, radiation therapy, or silicosis Silicosis Silicosis is permanent scarring of the lungs caused by inhaling silica (quartz) dust. People develop difficulty breathing during exercise that sometimes progresses to shortness of breath even... read more . These disorders tend to cause chronic mediastinitis.
Chronic mediastinitis may result in fibrosing mediastinitis. In fibrosing mediastinitis, blood vessels or airways (bronchi) may become blocked.
Symptoms of Mediastinitis
An esophageal tear causes sudden, severe chest pain and shortness of breath. Some people have symptoms of infection such as fever and chills.
If mediastinitis develops after chest surgery, people may have drainage from the incision site.
People who have chronic fibrosing mediastinitis may gradually become short of breath.
Diagnosis of Mediastinitis
Chest x-ray and usually computed tomography (CT)
Doctors can often make the diagnosis of mediastinitis based on the symptoms if people have a condition that can cause mediastinitis—for example, if people have symptoms that suggest mediastinitis and have recently had a procedure involving the chest or the esophagus or have tuberculosis or another slowly developing infection.
When mediastinitis develops suddenly, symptoms are usually severe enough that doctors suspect it in people who cannot report possible causes, such as those who are intoxicated and do not remember vomiting forcefully or young children who may have swallowed a caustic substance or button battery.
The diagnosis is confirmed by a chest x-ray and usually CT.
When mediastinitis occurs in a person who has had median sternotomy, doctors may insert a needle into the chest through the breastbone and remove fluid for examination under a microscope (aspiration biopsy).
Treatment of Mediastinitis
Antibiotics
Sometimes surgery
Antibiotics are given to treat infection. Sometimes surgery is needed to drain infected fluid from the chest, to repair the tear in the esophagus, or both. There is no treatment for fibrosing mediastinitis.
