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Infectious mediastinitis after cardiac operations: computed tomographic findings
1Department of Thoracic and Cardiovascular Surgery, Jichi Medical School, Tochigi, Japan.
The Annals of Thoracic Surgery
|April 4, 1998
Summary
Poststernotomy infectious mediastinitis, a serious complication of cardiac surgery, can be detected by computed tomography. Characteristic findings include mediastinal swelling and bilateral pleural effusion, aiding early diagnosis and treatment.
Area of Science:
- Cardiothoracic Surgery
- Diagnostic Imaging
- Infectious Diseases
Background:
- Infectious mediastinitis following cardiac surgery presents a significant challenge due to its poor prognosis.
- Timely surgical interventions, including debridement and irrigation, are crucial for managing infectious mediastinitis.
Purpose of the Study:
- To evaluate the utility of computed tomography (CT) in diagnosing poststernotomy infectious mediastinitis.
- To identify characteristic CT findings associated with this complication.
Main Methods:
- A retrospective analysis of 722 cardiac surgery patients was conducted.
- Twenty-one patients developed mediastinitis; 11 underwent pre-resternotomy CT scans.
- Ten patients served as a control group, with CT scans performed 2-3 weeks post-operation.
Main Results:
- In the mediastinitis group, CT revealed mediastinal soft tissue swelling (7 patients), bilateral pleural effusion (9 patients), sternal dehiscence/erosion (8 patients), and subcutaneous fluid (7 patients).
- Control group findings included unilateral pleural effusion (6 patients), bilateral effusion (1 patient), and mediastinal soft tissue swelling (1 patient).
Conclusions:
- Mediastinal soft tissue mass with bilateral pleural effusion on CT may indicate poststernotomy infectious mediastinitis.
- Chest CT is highly sensitive for detecting sternal dehiscence, erosion, and subcutaneous fluid accumulation in these patients.