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Computed tomography findings of mediastinitis after cardiovascular surgery
Takahiro Hosokawa1, Yoshitake Yamada2, Yutaka Tanami1
1Department of Radiology, Saitama Children's Medical Center, Saitama, Japan.
Insights
Computed tomography (CT) reveals sternal destruction and capsular ring enhancement are key indicators for diagnosing mediastinitis in children after heart surgery. These CT findings aid in accurate diagnosis for pediatric patients.
Area of Science:
- Medical Imaging
- Pediatric Surgery
- Infectious Diseases
Background:
- Mediastinitis following cardiovascular surgery in children is a serious complication.
- Systematic studies on computed tomography (CT) imaging for pediatric post-cardiovascular surgery mediastinitis are lacking.
- This study aimed to evaluate CT findings in pediatric patients diagnosed with mediastinitis after cardiovascular surgery.
Purpose of the Study:
- To assess the diagnostic utility of specific computed tomography (CT) findings in pediatric patients with mediastinitis post-cardiovascular surgery.
- To identify CT features that differentiate between mediastinitis and non-mediastinitis cases in this population.
- To establish the accuracy of CT in diagnosing pediatric mediastinitis after cardiac procedures.
Main Methods:
- Retrospective analysis of 28 pediatric patients undergoing CT for suspected mediastinitis post-cardiovascular surgery.
- Comparison of CT findings (mediastinal fluid, free gas, sternal destruction, capsular ring enhancement) between patients with (n=15) and without (n=13) mediastinitis.
- Statistical analysis using Fisher's exact test and Receiver Operating Characteristic (ROC) curve analysis to determine diagnostic accuracy.
Main Results:
- Sternal destruction was significantly more prevalent in patients with mediastinitis (73.6%) compared to those without (0%, P < 0.0001).
- Capsular ring enhancement was observed in 100% of mediastinitis cases versus 38.5% in the control group (P = 0.0004).
- A 'whole rim enhancement' cut-off on ROC analysis yielded 100% sensitivity and 92.3% specificity for mediastinitis diagnosis.
Conclusions:
- CT findings of sternal destruction and capsular ring enhancement are significantly associated with mediastinitis in pediatric patients post-cardiac surgery.
- These specific CT features are crucial for accurate diagnosis of mediastinitis in this vulnerable patient group.
- Careful assessment of sternal destruction and capsular ring enhancement on CT can improve diagnostic accuracy for pediatric post-cardiac surgery mediastinitis.
Background:
To our knowledge, no systematic study has been conducted on computed tomography (CT) imaging of mediastinitis in children post-cardiovascular surgery. We aimed to assess the CT findings of pediatric patients diagnosed with mediastinitis after cardiovascular surgery.
Methods:
We included 28 pediatric patients with suspected mediastinitis after undergoing cardiovascular surgery and who underwent CT. Patients were divided into a group with mediastinitis requiring antibiotic therapy (n = 15) confirmed by positive bacterial culture from the mediastinum and a group without mediastinitis (n = 13). Fisher's exact test was used to compare the following CT findings between the two groups: (i) mediastinal fluid collection; (ii) free gas bubble within fluid collection; (iii) sternal destruction; and (iv) capsular ring enhancement. The enhancement extent was categorized into the following four grades: whole rim enhancement, >50% of the rim enhancement, <50% of the rim enhancement, and no rim enhancement. A receiver operating characteristic curve analysis was performed to establish a cut-off point for obtaining the maximum diagnostic accuracy.
Results:
A significant difference was observed between patients, with and without mediastinitis in sternal destruction (73.6% vs 0%, P = <0.0001) and capsular ring enhancement (100.0% vs 38.5%, P = 0.0004). By using a cut-off grade of the whole rim enhancement, the estimated sensitivity and specificity for mediastinitis diagnosis were 100% and 92.3%, respectively.
Conclusion:
Computed tomography findings of sternal destruction and capsular ring enhancement were observed more in patients with mediastinitis than in those without mediastinitis, and should be assessed carefully to diagnose mediastinitis accurately in pediatric patients who have undergone cardiac surgery.
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