Infectious Mediastinitis After Cardiac Operations: Computed Tomographic Findings

doi:10.1016/S0003-4975(97)01339-8

The Annals of Thoracic Surgery

Volume 65, Issue 3, March 1998, Pages 622-624

https://doi.org/10.1016/S0003-4975(97)01339-8 Get rights and content

Abstract

Background. Infectious mediastinitis after cardiac operations is of great concern to cardiac surgeons because of its poor prognosis. Prompt surgical interventions such as debridement and irrigation are the key to treatment of infectious mediastinitis.

Methods. We surveyed retrospectively the cases of 722 consecutive cardiac surgery patients at our hospital. Mediastinitis developed in 21 patients after the cardiac operation. We performed computed tomography in 11 of these patients before resternotomy and in 10 patients as the control 2 to 3 weeks after the cardiac operation.

Results. Mediastinal soft tissue swelling was seen in 7 patients, bilateral pleural effusion was found in 9 patients, sternal dehiscence or sternal erosion was observed in 8 patients, and subcutaneous fluid accumulation was found in 7 of the mediastinitis group. Unilateral pleural effusion was seen in 6 and bilateral effusion in 1, and mediastinal soft tissue swelling was seen in 1 patient of the control group.

Conclusions. Our study showed that mediastinal soft tissue mass combined with bilateral pleural effusion can be a characteristic computed tomography finding in post-sternotomy infectious mediastinitis, and that chest computed tomography is more sensitive to detecting sternal dehiscence, sternal erosion, and subcutaneous fluid accumulation.

Section snippets

Material and Methods

Seven hundred twenty-two consecutive patients, who had cardiac surgical procedures with extracorporeal circulation between 1990 and 1996, were included in this study. Mediastinitis developed after the cardiac operation in 21 of these patients (2.9%). There were 5 patients with ischemic heart disease, 2 with Stanford type A aortic dissection, 1 with valvular disease, 1 with atrial septal defect, and 1 with invasive hepatoma in the right atrium. All patients had undergone cardiopulmonary bypass

Results

Postoperative infectious mediastinitis occurred between 13 and 63 days (mean ± SD, 27 ± 15 days) after the initial operations. The 11 patients with mediastinitis had high fever and leukocytosis associated with high levels of C-reactive protein. Supraventricular arrhythmia developed in 8 of them, and 8 patients experienced appetite loss.

Table 1 shows the CT findings of each group. Bilateral pleural effusion and mediastinal soft tissue swelling were predominantly seen in the mediastinitis group.

Comment

The mediastinum has no mesothelium except inside the pericardium. Thus, conservative treatment for infectious mediastinitis after a cardiac operation tends to fail because of immunologic difficulties. Prompt surgical interventions such as debridement and irrigation are recommended for the treatment of infectious mediastinitis. However, the mediastinitis is often quite advanced before surgeons recognize it when they reexplore the mediastinum.

In this study, mediastinitis was diagnosed mainly on

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The CT findings that had the higher specificity were bone reabsorption (93%) and sternum diastasis (88%), but with very low sensitivity, 28% and 10%, respectively. Few publications about this subject have been published, and no large study was found (Exarhos et al., 2005; Yamashiro et al., 2008; Bitkover et al., 1999; Sa et al., 2011; Misawa et al., 1998; Yamaguchi et al., 2001). Although some studies suggest that certain chest CT findings (for example pleural/pericardial effusion, mediastinal collection, pneumomediastinum, sternum diastasis) could be associated with mediastinitis, these studies had only between 6 and 34 cases, which compromises an adequate analysis of the accuracy of the diagnostic test.
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Original ArticlesInfectious Mediastinitis After Cardiac Operations: Computed Tomographic Findings

Abstract

Section snippets

Material and Methods

Results

Comment

Ann Thorac Surg

Clin Radiol

Ann Thorac Surg

Poststernotomy mediastinitis

Heart Lung

Original Articles
Infectious Mediastinitis After Cardiac Operations: Computed Tomographic Findings