Mediastinal secondary infection

Overview neck fascia on the plane directly with the anatomy of mediastinal space plane and visceral connections. Mediastinal under the structure and the same plane through fascia and retroperitoneal linked to the upper area. From the operation on a regional gap infection, directly through this anatomical region into another anatomical region. In particular the origin of infection in the neck, not only because of gravity, durable because of the negative pressure downward chest spread to mediastinal within. And the gap between the above passage from the anatomical sense, retropharyngeal space, the space trachea, sternum space, neck and esophageal vascular sheath surrounding space, and so on. In recent years, cardiovascular surgery and sternotomy saw increasing cases of postoperative mediastinal infection rates have increased. Mediastinal infection causes the most common bacteria is Staphylococcus aureus, Staphylococcus white, Staphylococcus aureus or Staphylococcus epidermidis, and other Gram-negative is Enterobacteriaceae, such as gas-producing bacteria, and Alkali production bacilli and Proteus, Clostridium perfringens, Pseudomonas aeruginosa. In recent years, because of routine use of broad-spectrum antibiotics, Staphylococcus aureus has been rare, often Wound cultures were negative. In chronic infections often find mold, such as Candida albicans. Pathogenesis mediastinal tube rupture within different causes esophagus, trachea and bronchial rupture can cause purulent mediastinal infection. Acute upper mediastinal infection, mostly due to neck or chest injuries caused esophagus; For example, esophagoscopy, iatrogenic injury caused equipment, esophageal foreign body penetrating erosion of the wall and other food. The previous hard metal tube endoscopy easier to produce such holes. Esophageal surgery caused intrathoracic anastomotic fistula, is acute mediastinal infection common causes However, such a rapid spread of inflammation over to the chest, covering the acute mediastinal infection. Severe vomiting induced spontaneous rupture of the esophagus, the main produce lethal mediastinal infection. Clearance by the trachea ago, pharynx perirenal space, prevertebral space down on the spread of mediastinal can cause infection. As superficial neck facilitate drainage antibiotics are easier to control, by the neck cellulitis, Acute lymphadenitis progress to acute upper mediastinal infection also have a mediastinal infection causes. Intrathoracic pyogenic lesions, such as empyema, the neighboring mediastinal suppurative lung disease, you can directly reach disseminated within the mediastinum. From acute suppurative pericarditis and retroperitoneal area uplink infection caused mediastinal infection are extremely rare. In cardiac surgery, particularly through a median sternotomy cases, the need for postoperative patients tracheotomy, Since surgery on sternum separation of Waterloo, making tracheotomy incision and sternum after the same space, some logistics into the trachea endocrine mediastinal caused mediastinal infection. Clinical reported. Diagnostic Method Based on the above diagnosis history, examination of esophageal or mediastinal after penetrating wounds soon after the emergence of high fever, chills, prostrate with shock, substernal pain, difficulty in breathing, heart rate increase. Such as esophageal or tracheal injury, early submissions can be made in the neck skin and subcutaneous emphysema twist pronunciation, subcutaneous emphysema started in neck to the body and quickly dispersed. WBC increased to varying degrees, and some can be as high as 30 × 109 / L (3000/mm3) above. When mediastinal infection acute disseminated to the bilateral hilar region, a significant area's scapular pain. When sternal instability, patients often complained of chest incision pain, particularly in the cough, expectoration, thoracic violent vibration, Friction can sternum Mobile flu. If the merger infection, fever response generally has not. When sternum quiver opened obvious epidermal often cracks from the quiver completely open incision, it can be seen as two sides of the chest muscles and breathing a big movement, it will be staggered to interference phenomena affect respiratory function, so that there is shortness of breath, fast heart rate increased. Physical examination, according to early patients sternum palpable on both sides, in a deep breath when breast Mobile flu, obviously, Friction can still hear the sound sternum. For epidermal small gap in deep sniff or coughing small bubbles can be seen from the mediastinal extruder. Completely open quiver, will be shown from the wound to see the mediastinum, heart and pericardium. In short, the use of breast median sternotomy in cardiac surgery as a result of friction flu sternum, Pressing sternum in a deep sense of a mobile signs that can open the sternum quiver diagnosis. Open heart surgery, as the temperature rose to above 39 ° C, sustained 4 ~ 5 days without a downward trend, or decrease in future high fever; carefully check incision, as parasternal marked tenderness and (or) sternum Mobile flu, or any purulent secretions or bubbles, which can be sure of the diagnosis of mediastinal infection. X-ray photographs sternum instance, substernal deepening shadow of the plot or gas is also helpful to the diagnosis. When necessary, may attract mediastinal puncture or puncture xiphoid process can extract purulent secretions.