Mediastina

Mediastina - inflammation of the tissue of the mediastinum. Occurs as a complication of purulent diseases of the pleura, the lung, mouth, throat, neck, and so on, because of injury of mediastinal organs (for example, a perforation of the esophagus foreign body) or after surgery (for example, resection of the esophagus). Mediastina accompanied by severe intoxication due to the rapid absorption of toxic products from the middle of inflammation. Symptoms: shortness of breath, pain in the chest and back pain, chills, fever, hoarseness, sometimes dizziness. The most severe complication of mediastinitis - compression and perforation of neighboring organs (trachea, esophagus, vessels). Forecast when mediastinitis always serious.
Important in the diagnosis of mediastinitis belongs to x-ray study (see Pneumomediastinum).
If you suspect mediastina shown immediate hospitalization.
Treatment: large doses of broad-spectrum antibiotics, when anaerobic infection (see) - whey, heart drugs, vitamin therapy; fluids, glucose, plasma, blood transfusion. Special attention is paid to the nutrition of patients and oxygen therapy (see).
When the abscess formation and suspected putrid infection shows mediastinotomy (see). In the postoperative period it is important to ensure the active outflow of pus from a lesion.

Mediastinum (mediastinitis, from late Latin mediastinum - mediastinum) - inflammation of the tissue of the mediastinum.
There are acute and chronic mediastinum. Acute mediastina both primary and secondary invoked pyogenic infection. Primary M. occur during a direct penetration of the infection in mediastinal tissue - injuries of the neck, esophagus, pharynx or trachea. The most common cause of acute primary Meters are perforation and breaks esophagus foreign bodies and instruments (esophagoscopy, Buji, straddling and other). Secondary mediastinitis divided into contact and metastatic. They are a complication of cellulitis or abscess neck, pneumonia, lung abscesses, osteomyelitis of sternum, vertebral, and other
The nature of pathological changes are distinguished: 1) acute serous M (acute swelling of the mediastinum); 2) acute mediastinal infiltration; 3) acute mediastinal abscess; 4) flegmonas-gangrenous M localization are M front, rear, top, bifurcation and lower divisions of the mediastinum (see). The clinical course of mediastinal can be lightning fast, quickly or slowly flowing.
Diagnosis is difficult, especially in cases of secondary mediastinitis, complicating the course of the underlying disease. Recognition of primary PM, caused by the rupture or perforation of the esophagus or trachea, facilitated anamnestic data and the characteristic attributes of infringement of an integrity of these bodies.
For acute M. typical appearance of the chest or interscapular pain worse when swallowing and crowding of the head (symptom A. E. Romanov), and with the localization process is in the lower part of the mediastinum - in epigastralna area with the muscles of the anterior abdominal wall and peritoneal phenomena. The increase of temperature, increased heart rate, leukocytosis and left shift formula vary widely. With the localization process in the upper division of the mediastinum are marked tension of the neck muscles, edema, infiltration, and in advanced cases, and the formation of abscesses soft tissues of the neck, over the handle of the sternum and in supraclavicular pits. In acute mediastinitis developing in probodeniem esophagus or trachea, along with the listed symptoms are identified dysphagia and the presence of gas in okoloplodna tissue neck and mediastinum, and later in the subcutaneous tissue of the neck.
Percussion and auscultation data in recognition M not play a significant role. Syndrome collar Stokes (compression of the upper Vena cava) is observed very rarely. Guardedly should treat diagnostic puncture mediastinum, which in any location of the inflammatory process is fraught with the danger of injury and infection of the pleura, pericardium and large vessels. Diagnostic value of ezofagoskopia also small. The leading role in the recognition of mediastinitis belongs to x-ray study, relatively early revealing inflammatory changes in the form of edema (extension prevertebral gap) and infiltration of separate zones mediastinum or presence in the last cavity, sometimes with the horizontal level of the liquid and gas bubble above it. Contrast examination of the esophagus helps to identify the level and nature of his defeat (rupture, perforation), caused the development of M (see Pneumomediastinum).
In acute mediastinitis forecast always serious.
Conservative treatment with antibiotics shown in the initial stages. The development of purulent process in the mediastinum requires surgical treatment that amounts to a wide exterior drainage mediastinal cellulitis or abscess (see Mediastinotomy). At the monastery, arising as a result of rupture or perforation of the esophagus, external drainage paraesophageal fiber should be made at the earliest possible time (the first 6-12 hour.) and match with primary suture of the wound of the esophagus and off last. This is achieved by the transfer of the patient to parenteral feeding, or feeding it through transnasal thin probe; in severe injury of the esophagus shows the imposition gastrostomy.
Chronic mediastina called or specific infection (tuberculosis, syphilis, actinomycosis), or is the outcome of acute mediastinitis. The incursion from primary focus is hematogenous or lymphogenous by (metastatic M) or by direct distribution from the primary tumor - pin M. Diagnosis of chronic M. difficult due to the layering of the symptoms of the underlying disease. Nerezko expressed chest and interscapular pain or discomfort in these areas, low-grade fever, adherence indrawing during inhalation (symptom Century A. Ravich-Scherbo), parasternal ripple (symptom N. N. Ignatovskaya), increased sensitivity to pain abdominal aorta (the symptom M. I. of Birenbaum), expansion of percussion borders of the upper anterior mediastinum ("symptom bowl" I. P. philosofova) characterize the clinical manifestation of chronic mediastinitis specific etiology, diagnosis which are important radiological and laboratory tests.
Chronic specific M require appropriate medical treatment - TB or protevoepilepticescoe. Surgery may be indicated in cases of occurrence of secondary Cicatricial deformities, mediastinal or liquidation of the primary site.