• Inflammation of the mediastinum
    • Commonly caused by esophageal rupture or perforation
    • Infection may be caused by esophageal rupture/perforation or spread of infection from remote site
      • Streptococcus and Bacteroides


Clinical Features

Differential Diagnosis


  • CXR - often first modality
    • Typically reveals subcutaneous emphysema, widening of the mediastinum and pleural effusions
  • CT with IV contrast if diagnosis in doubt
  • Septic workup to include:
    • CBC
    • Lactic acid
    • Blood cultures (incl gram Stain)
    • Cultures of mediastinal fluid


  • Aggressive airway management
  • Patients with mediastinitis emergently require surgery
    • Consult
      • CT Surgery for repair
      • ENT if upper neck area
      • GI for possible endoscopy
  • Start broad-spectrum antibiotics to include Pseudomonal coverage[2]


  • Admit to ICU

See Also


  1. Infections of the mediastinum. SB - Thorac Surg Clin 2009 Feb; PMID 19288819
  2. El Oakley, RM et al. Postoperative mediastinitis: classification and management. Ann Thorac Surg. 1996. PMID 8619682