Mediastinitis

Anatomía y Etiología

Anatomía

Mediastino:

• Compartimento central de la cavidad torácica bordeado por:
  • Sacos pleurales pulmonares lateralmente
  • Salida torácica superiormente
  • Diafragma inferiormente
• Estructuras dentro del mediastino:
  • Corazón
  • Timo
  • Grandes vasos (vena cava, aorta Aorta The main trunk of the systemic arteries. Mediastinum and Great Vessels: Anatomy, arterias pulmonares)
  • Esófago
  • Porción distal de la tráquea
  • Bronquios principales
  • Nervio frénico
  • Nervio vago ( par PAR The PAR is the attributable risk for an entire population. It represents the fraction of cases that would not occur in a population if the exposure was eliminated. Measures of Risk craneal X)

Etiología

Mediastinitis Mediastinitis Mediastinitis refers to an infection or inflammation involving the mediastinum (a region in the thoracic cavity containing the heart, thymus gland, portions of the esophagus, and trachea). Acute mediastinitis can be caused by bacterial infection due to direct contamination, hematogenous or lymphatic spread, or extension of infection from nearby structures. Mediastinitis aguda:

• Perforación esofágica:
  • Una causa principal
  • Antecedente de vómitos severos
  • Hematemesis Hematemesis Vomiting of blood that is either fresh bright red, or older ‘coffee-ground’ in character. It generally indicates bleeding of the upper gastrointestinal tract. Mallory-Weiss Syndrome (Mallory-Weiss Tear)
  • Dolor Dolor Inflammation y edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema de cuello, de inicio repentino
  • Dolor Dolor Inflammation al AL Amyloidosis deglutir
• Mediastinitis Mediastinitis Mediastinitis refers to an infection or inflammation involving the mediastinum (a region in the thoracic cavity containing the heart, thymus gland, portions of the esophagus, and trachea). Acute mediastinitis can be caused by bacterial infection due to direct contamination, hematogenous or lymphatic spread, or extension of infection from nearby structures. Mediastinitis postoperatoria:
  • Una de las causas más comunes
  • 1%–2% de cirugías cardíacas
  • Fiebre, dolor Dolor Inflammation torácico, herida torácica purulenta o eritematosa
  • La mayoría de los LOS Neisseria pacientes se presentan dentro de 1 mes de la cirugía.
• Mediastinitis Mediastinitis Mediastinitis refers to an infection or inflammation involving the mediastinum (a region in the thoracic cavity containing the heart, thymus gland, portions of the esophagus, and trachea). Acute mediastinitis can be caused by bacterial infection due to direct contamination, hematogenous or lymphatic spread, or extension of infection from nearby structures. Mediastinitis necrosante descendente:
  • Generalmente, extensión directa (absceso retrofaríngeo, amigdalitis, faringitis, epiglotitis)
  • Empeoramiento del dolor Dolor Inflammation de garganta y/o el edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema del cuello
  • Fiebre, dolor Dolor Inflammation torácico, dificultad para respirar
  • Se ha HA Hemolytic anemia (HA) is the term given to a large group of anemias that are caused by the premature destruction/hemolysis of circulating red blood cells (RBCs). Hemolysis can occur within (intravascular hemolysis) or outside the blood vessels (extravascular hemolysis). Hemolytic Anemia vuelto menos frecuente debido al AL Amyloidosis uso de antibióticos

Mediastinitis Mediastinitis Mediastinitis refers to an infection or inflammation involving the mediastinum (a region in the thoracic cavity containing the heart, thymus gland, portions of the esophagus, and trachea). Acute mediastinitis can be caused by bacterial infection due to direct contamination, hematogenous or lymphatic spread, or extension of infection from nearby structures. Mediastinitis crónica:

Mediastinitis Mediastinitis Mediastinitis refers to an infection or inflammation involving the mediastinum (a region in the thoracic cavity containing the heart, thymus gland, portions of the esophagus, and trachea). Acute mediastinitis can be caused by bacterial infection due to direct contamination, hematogenous or lymphatic spread, or extension of infection from nearby structures. Mediastinitis fibrosante:

• Relacionada con afecciones inflamatorias crónicas
• Marcada por el crecimiento de colágeno acelular y tejido fibroso dentro del tórax
• Mediastinitis Mediastinitis Mediastinitis refers to an infection or inflammation involving the mediastinum (a region in the thoracic cavity containing the heart, thymus gland, portions of the esophagus, and trachea). Acute mediastinitis can be caused by bacterial infection due to direct contamination, hematogenous or lymphatic spread, or extension of infection from nearby structures. Mediastinitis granulomatosa ( histoplasmosis Histoplasmosis Histoplasmosis is an infection caused by Histoplasma capsulatum, a dimorphic fungus. Transmission is through inhalation, and exposure to soils containing bird or bat droppings increases the risk of infection. Most infections are asymptomatic; however, immunocompromised individuals generally develop acute pulmonary infection, chronic infection, or even disseminated disease. Histoplasma/Histoplasmosis, infecciones tuberculosas)
• Mediastinitis Mediastinitis Mediastinitis refers to an infection or inflammation involving the mediastinum (a region in the thoracic cavity containing the heart, thymus gland, portions of the esophagus, and trachea). Acute mediastinitis can be caused by bacterial infection due to direct contamination, hematogenous or lymphatic spread, or extension of infection from nearby structures. Mediastinitis fibrosante no granulomatosa (reacción a medicamentos o radioterapia)
• Enfermedades autoinmunes (enfermedad de Behcet)

Diagnóstico

Antecedentes

• Síntomas:
  • Tos TOS Thoracic outlet syndrome (TOS) is a broad term used for a spectrum of syndromes related to the general region of the thoracic outlet, which involves the compression or irritation of elements of the brachial plexus, subclavian artery, or subclavian vein. Thoracic Outlet Syndrome
  • Fiebre
  • Dolor Dolor Inflammation de garganta
  • Dolor Dolor Inflammation torácico
  • Dolor Dolor Inflammation al AL Amyloidosis deglutir
  • Vómitos severos
• Antecedente de:
  • Cirugía reciente
  • Enfermedad autoinmune

Examen físico

Mediastinitis Mediastinitis Mediastinitis refers to an infection or inflammation involving the mediastinum (a region in the thoracic cavity containing the heart, thymus gland, portions of the esophagus, and trachea). Acute mediastinitis can be caused by bacterial infection due to direct contamination, hematogenous or lymphatic spread, or extension of infection from nearby structures. Mediastinitis aguda:

• “Aspecto enfermizo”
• Fiebre
• Escalofríos
• Taquicardia
• Dolor Dolor Inflammation torácico
• Odinofagia
• Déficits de los LOS Neisseria pares craneales (IX, X, XI y XII)
• Leucocitosis
• Drenaje de heridas o secreción purulenta

Mediastinitis Mediastinitis Mediastinitis refers to an infection or inflammation involving the mediastinum (a region in the thoracic cavity containing the heart, thymus gland, portions of the esophagus, and trachea). Acute mediastinitis can be caused by bacterial infection due to direct contamination, hematogenous or lymphatic spread, or extension of infection from nearby structures. Mediastinitis crónica:

• Progresión insidiosa
• Las vías aéreas contraídas causan tos TOS Thoracic outlet syndrome (TOS) is a broad term used for a spectrum of syndromes related to the general region of the thoracic outlet, which involves the compression or irritation of elements of the brachial plexus, subclavian artery, or subclavian vein. Thoracic Outlet Syndrome y dificultad para respirar.
• El esófago contraído provoca dificultad para deglutir.
• Los LOS Neisseria vasos sanguíneos contraídos causan hemoptisis y dolor Dolor Inflammation torácico.

Pruebas de laboratorio

• Hemograma: leucocitos elevados (no específicos para infección aguda)
• Marcadores inflamatorios:
  • PCR PCR Polymerase chain reaction (PCR) is a technique that amplifies DNA fragments exponentially for analysis. The process is highly specific, allowing for the targeting of specific genomic sequences, even with minuscule sample amounts. The PCR cycles multiple times through 3 phases: denaturation of the template DNA, annealing of a specific primer to the individual DNA strands, and synthesis/elongation of new DNA molecules. Polymerase Chain Reaction (PCR) elevada
  • Procalcitonina elevada
• Aspiración mediastínica:
  • Invasiva
  • Permite el cultivo y el enfoque en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el agente infeccioso
• Hemocultivos:
  • Puede revelar un patógeno bacteriano
  • Especialmente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum casos postoperatorios

Imagenología

• Radiografía de tórax:
  • Masa hiliar
  • Mediastino ensanchado
  • Neumomediastino
• TC:
  • Absceso mediastínico/masa hiliar
  • Edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema
  • Si hay afectación pericárdica:
    • Engrosamiento pericárdico
    • Derrame pericárdico
    • Neumopericardio
  • Mediastinitis Mediastinitis Mediastinitis refers to an infection or inflammation involving the mediastinum (a region in the thoracic cavity containing the heart, thymus gland, portions of the esophagus, and trachea). Acute mediastinitis can be caused by bacterial infection due to direct contamination, hematogenous or lymphatic spread, or extension of infection from nearby structures. Mediastinitis fibrosante
    • Calcificaciones
    • Masa infiltrante

Tratamiento

Mediastinitis Mediastinitis Mediastinitis refers to an infection or inflammation involving the mediastinum (a region in the thoracic cavity containing the heart, thymus gland, portions of the esophagus, and trachea). Acute mediastinitis can be caused by bacterial infection due to direct contamination, hematogenous or lymphatic spread, or extension of infection from nearby structures. Mediastinitis aguda:

• Antibióticos:
  • Inicialmente, de amplio espectro
  • Guiados por cultivo cuando sea posible
• Drenaje quirúrgico y desbridamiento
• Alta tasa de mortalidad (10%–50%), incluso con el tratamiento adecuado

Mediastinitis Mediastinitis Mediastinitis refers to an infection or inflammation involving the mediastinum (a region in the thoracic cavity containing the heart, thymus gland, portions of the esophagus, and trachea). Acute mediastinitis can be caused by bacterial infection due to direct contamination, hematogenous or lymphatic spread, or extension of infection from nearby structures. Mediastinitis crónica fibrosante:

• Falta de consenso
• Tratar la afección subyacente cuando se conozca.
• Medicamentos:
  • Inmunosupresores
  • Corticosteroides
  • Antifúngicos
• Descompresión quirúrgica de la estructura afectada

Relevancia Clínica

• Absceso retrofaríngeo: localizado detrás de la pared faríngea posterior en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el espacio retrofaríngeo. Generalmente, se presenta con rigidez nucal y dificultad para deglutir. Puede pasar del espacio parafaríngeo al AL Amyloidosis retrofaríngeo y luego detrás del esófago hacia el mediastino. El tratamiento consiste en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el drenaje y la administración de antibióticos.
• Epiglotitis: inflamación potencialmente mortal de la epiglotis y las estructuras circundantes, generalmente secundaria a una infección bacteriana. Los LOS Neisseria síntomas son de aparición rápida y graves. Puede causar obstrucción de las vías aéreas, lo que provoca dificultad para respirar, estridor y decoloración azulada de la piel, lo que finalmente conduce a la muerte. El diagnóstico se realiza mediante la visualización directa de la epiglotis mediante laringoscopia de fibra óptica directa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el quirófano.
• Histoplasmosis Histoplasmosis Histoplasmosis is an infection caused by Histoplasma capsulatum, a dimorphic fungus. Transmission is through inhalation, and exposure to soils containing bird or bat droppings increases the risk of infection. Most infections are asymptomatic; however, immunocompromised individuals generally develop acute pulmonary infection, chronic infection, or even disseminated disease. Histoplasma/Histoplasmosis: rara infección fúngica de los LOS Neisseria pulmones causada por la inhalación de esporas de Histoplasma capsulatum Histoplasma capsulatum Histoplasma/Histoplasmosis, que a menudo se encuentran en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria excrementos de murciélagos y pájaros, lo que puede provocar mediastinitis Mediastinitis Mediastinitis refers to an infection or inflammation involving the mediastinum (a region in the thoracic cavity containing the heart, thymus gland, portions of the esophagus, and trachea). Acute mediastinitis can be caused by bacterial infection due to direct contamination, hematogenous or lymphatic spread, or extension of infection from nearby structures. Mediastinitis granulomatosa. Se presenta con tos TOS Thoracic outlet syndrome (TOS) is a broad term used for a spectrum of syndromes related to the general region of the thoracic outlet, which involves the compression or irritation of elements of the brachial plexus, subclavian artery, or subclavian vein. Thoracic Outlet Syndrome y disnea, acompañada de ganglios linfáticos (o masas) mediastínicos o hiliares, o de artralgias y eritema nodoso. El tratamiento consiste en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum medicamentos antimicóticos de duración y concentración variadas según la gravedad de la infección.
• Tuberculosis Tuberculosis Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis complex bacteria. The bacteria usually attack the lungs but can also damage other parts of the body. Approximately 30% of people around the world are infected with this pathogen, with the majority harboring a latent infection. Tuberculosis spreads through the air when a person with active pulmonary infection coughs or sneezes. Tuberculosis ( TB TB Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis complex bacteria. The bacteria usually attack the lungs but can also damage other parts of the body. Approximately 30% of people around the world are infected with this pathogen, with the majority harboring a latent infection. Tuberculosis spreads through the air when a person with active pulmonary infection coughs or sneezes. Tuberculosis): enfermedad causada por Mycobacterium tuberculosis Mycobacterium tuberculosis Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis complex bacteria. The bacteria usually attack the lungs but can also damage other parts of the body. Approximately 30% of people around the world are infected with this pathogen, with the majority harboring a latent infection. Tuberculosis spreads through the air when a person with active pulmonary infection coughs or sneezes. Tuberculosis. Las bacterias generalmente atacan los LOS Neisseria pulmones, pero también pueden afectar otras partes del cuerpo. Se propaga por el aire cuando una persona infectada con TB TB Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis complex bacteria. The bacteria usually attack the lungs but can also damage other parts of the body. Approximately 30% of people around the world are infected with this pathogen, with the majority harboring a latent infection. Tuberculosis spreads through the air when a person with active pulmonary infection coughs or sneezes. Tuberculosis de los LOS Neisseria pulmones o la garganta habla, estornuda o tose. La infección crónica por TB TB Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis complex bacteria. The bacteria usually attack the lungs but can also damage other parts of the body. Approximately 30% of people around the world are infected with this pathogen, with the majority harboring a latent infection. Tuberculosis spreads through the air when a person with active pulmonary infection coughs or sneezes. Tuberculosis puede causar mediastinitis Mediastinitis Mediastinitis refers to an infection or inflammation involving the mediastinum (a region in the thoracic cavity containing the heart, thymus gland, portions of the esophagus, and trachea). Acute mediastinitis can be caused by bacterial infection due to direct contamination, hematogenous or lymphatic spread, or extension of infection from nearby structures. Mediastinitis granulomatosa.
• Ingestión de cáusticos: los LOS Neisseria agentes cáusticos son sustancias ácidas o alcalinas que pueden dañar gravemente los LOS Neisseria tejidos orgánicos. La ingestión de álcali típicamente daña el esófago, mientras que los LOS Neisseria ácidos causan lesiones gástricas más graves. Ambos tipos pueden causar lesión laríngea y traqueobronquial. El tratamiento implica asegurar las vías aéreas, verificar la respiración y la circulación, la descontaminación (quitar la ropa, irrigación de la piel) y la endoscopia dentro de las 24 horas.
  Perforación esofágica: afección potencialmente mortal que resulta de ruptura espontánea (síndrome de Boerhaave), causas iatrogénicas (endoscopia), causas infecciosas o úlceras esofágicas. Se presenta con dolor Dolor Inflammation torácico, taquipnea y derrame pleural. El tratamiento involucra antibióticos y reparación quirúrgica. Debido a su ubicación adyacente al AL Amyloidosis mediastino, la perforación esofágica puede complicarse con una mediastinitis Mediastinitis Mediastinitis refers to an infection or inflammation involving the mediastinum (a region in the thoracic cavity containing the heart, thymus gland, portions of the esophagus, and trachea). Acute mediastinitis can be caused by bacterial infection due to direct contamination, hematogenous or lymphatic spread, or extension of infection from nearby structures. Mediastinitis aguda.