ABSTRACT
OBJECTIVE: To describe and clarify management protocols in relation to spontaneous pneumomediastinum, and try to integrate criteria on this subject. BACKGROUND: Thoracic physicians are faced with patients who present with gas in the mediastinum, frequently without an obvious etiologic factor. Published material contains heterogeneous information from which different conclusions can be drawn. METHODS: In a Medline search from 1990 to 2012, we collected data on mortality, morbidity, signs, symptoms, etiologic factors, and diagnostic methods. Standardized mean differences were calculated. RESULTS: We identified 600 patients in 27 papers with series of >5 patients without precipitating or etiologic factors previous to the clinical presentation, but athletic activity, drug abuse, and history of asthma played an apparent role in the disease process. Most patients complained of thoracic pain and dyspnea, with subcutaneous emphysema and Hamman's sign. The most common complication was tension pneumothorax. Morbidity was seen in 2.8%; no mortality has been reported so far. CONCLUSION: Spontaneous pneumomediastinum is a rare disease with a benign course, which should be treated conservatively unless a complication mandates an invasive procedure. An algorithm for diagnosis and treatment is offered, based on the available evidence.
Subject(s)
Mediastinal Emphysema/therapy , Algorithms , Critical Pathways , Humans , Mediastinal Emphysema/diagnosis , Mediastinal Emphysema/etiology , Mediastinal Emphysema/mortality , Predictive Value of Tests , Risk Factors , Treatment OutcomeSubject(s)
Lung/abnormalities , Humans , Lung/physiopathology , Lung/surgery , Male , Middle Aged , Thoracotomy , Treatment OutcomeABSTRACT
BACKGROUND: Descending necrotizing mediastinitis is a dreadful disease with a high mortality rate, particularly when below the tracheal carina. This study describes the epidemiologic, clinical, and paraclinical features of patients treated for this condition. METHODS: We performed a single-center retrospective descriptive review of 60 patients with descending necrotizing mediastinitis below the tracheal carina, who were treated during a 7-year period, the largest study in the last 50 years. Demographic, clinical, paraclinical, and therapeutic variables were analyzed. RESULTS: 43 (71.7%) patients were male. The mean age was 41.2 ± 14.7 years. Mean hospital length of stay was 25.0 ± 19.8 days. Comorbidities were present in 46.7% of patients, diabetes mellitus being the most common. Odontogenic infections (45%) were the most frequent source of descending necrotizing mediastinitis. Cultures showed Gram-negative bacilli in 68.3%, Gram-positive cocci in 38.3%, and fungi in 6.7%. Mortality was 35% (21 patients); risk factors for mortality were age (>35 years), diabetes mellitus among other comorbidities, and associated complications. CONCLUSIONS: In this low socioeconomic status patient population, descending necrotizing mediastinitis below the carina causes high morbidity and mortality, the latter particularly associated with age, complications, diabetes mellitus and other comorbidities.
Subject(s)
Mediastinitis , Adult , Age Factors , Aged , Combined Modality Therapy , Comorbidity , Female , Humans , Length of Stay , Male , Mediastinitis/diagnosis , Mediastinitis/microbiology , Mediastinitis/mortality , Mediastinitis/therapy , Mexico/epidemiology , Middle Aged , Necrosis , Patient Care Team , Retrospective Studies , Risk Factors , Socioeconomic Factors , Time Factors , Treatment OutcomeABSTRACT
Lipomas are benign mesenchymal tumors that develop in areas of abundant adipose tissue. Due to the fatty composition of the breast, difficulties in diagnosis, treatment, and reconstruction are often encountered. We report a case of a 55-year-old female with a giant tumor of the right breast that comprised most of its mass, causing breast asymmetry. A thorough preoperative evaluation, followed by an uneventful difficult surgical resection and reconstruction, resulted in diagnosis of a benign lipoma. The case prompted this report because of its challenging size, location, diagnosis, and reconstructive solution.
Subject(s)
Heart Ventricles/pathology , Leiomyoma/pathology , Retroperitoneal Neoplasms/pathology , Uterine Neoplasms/pathology , Vena Cava, Inferior/pathology , Biopsy , Female , Heart Ventricles/diagnostic imaging , Heart Ventricles/surgery , Humans , Leiomyoma/diagnostic imaging , Leiomyoma/surgery , Middle Aged , Neoplasm Invasiveness , Retroperitoneal Neoplasms/diagnostic imaging , Retroperitoneal Neoplasms/surgery , Tomography, X-Ray Computed , Uterine Neoplasms/diagnostic imaging , Uterine Neoplasms/surgery , Vena Cava, Inferior/diagnostic imaging , Vena Cava, Inferior/surgeryABSTRACT
Descending necrotizing mediastinitis is usually associated with cervical or odontogenic infections. We describe a patient with blunt trauma to the chest 2 years earlier, and a slowly developing chest wall hematoma 18 months prior to admission, complicated by chronic sternoclavicular joint osteomyelitis, eventually leading to descending mediastinitis. Thoracotomy with drainage of the mediastinal spaces and multiple procedures for the sternoclavicular joint infection were successful. The rarity of this association and undefined optimal management prompted this report.
Subject(s)
Escherichia coli Infections/microbiology , Mediastinitis/microbiology , Osteomyelitis/microbiology , Staphylococcal Infections/microbiology , Sternoclavicular Joint/microbiology , Anti-Bacterial Agents/therapeutic use , Combined Modality Therapy , Debridement , Drainage , Escherichia coli Infections/diagnosis , Escherichia coli Infections/therapy , Female , Humans , Mediastinitis/diagnosis , Mediastinitis/therapy , Middle Aged , Necrosis , Osteomyelitis/diagnosis , Osteomyelitis/therapy , Risk Factors , Staphylococcal Infections/diagnosis , Staphylococcal Infections/therapy , Therapeutic Irrigation , Thoracotomy , Time Factors , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
A 22-year-old man with varicella had associated cervical enlargement, right upper thoracic anterior and suprascapular cellulitis, and mediastinitis. A tracheostomy, right posterolateral thoracotomy, cervicotomy, and upper thoracic fasciotomy were performed 14 h after admission, draining purulent exudates from all sites. The patient was discharged on postoperative day 22.
Subject(s)
Cellulitis/surgery , Chickenpox/complications , Mediastinitis/surgery , Cellulitis/etiology , Drainage , Humans , Male , Mediastinitis/diagnostic imaging , Mediastinitis/etiology , Radiography , Thoracotomy , Tracheostomy , Treatment Outcome , Young AdultSubject(s)
Abnormalities, Multiple , Coronary Vessel Anomalies/complications , Lung Diseases/complications , Abnormalities, Multiple/diagnostic imaging , Coronary Vessel Anomalies/diagnostic imaging , Humans , Lung/abnormalities , Lung/diagnostic imaging , Lung Diseases/diagnostic imaging , Male , Middle Aged , RadiographyABSTRACT
We report the case of a 42-year old diabetic male presenting with erythema of the neck and anterior right thoracic region secondary to the application of an ointment derived from rattlesnakes, progressing to a full-blown necrotizing fasciitis in a short period of time, with associated mediastinitis, thrombocytopaenia and sepsis. The patient died despite aggressive multidisciplinary medical and surgical treatment. We present this case due to the unusual aetiology and fulminating course.
