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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2012/07/02 21:05:18」(JST)

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Mediastinitis is inflammation of the tissues in the mid-chest, or mediastinum. It can be either acute or chronic.

Acute mediastinitis is usually bacterial and due to rupture of organs in the mediastinum. As the infection can progress rapidly, this is considered a serious condition. Chronic sclerosing (or fibrosing) mediastinitis, while potentially serious, is caused by a long-standing inflammation of the mediastinum, leading to growth of acellular collagen and fibrous tissue within the chest and around the central vessels and airways. It has a different cause, treatment, and prognosis than acute infectious mediastinitis.

Causes and treatment

Acute

Before the development of modern cardiovascular surgery, cases of acute mediastinitis usually arose from either perforation of the esophagus or from contiguous spread of odontogenic or retropharyngeal infections. However, in modern practice, most cases of acute mediastinitis result from complications of cardiovascular or endoscopic surgical procedures.

Treatment usually involves aggressive intravenous antibiotic therapy and hydration. If discrete fluid collections (such as abscesses) or grossly infected tissue have formed, they may have to be surgically drained or debrided.

Chronic

Chronic mediastinitis is usually a radiologic diagnosis manifested by diffuse fibrosis of the soft tissues of the mediastinum. This is sometimes the consequence of prior granulomatous disease, most commonly histoplasmosis. Other identifiable causes include tuberculosis and radiation therapy. Fibrosing mediastinitis most frequently causes problems by constricting blood vessels or airways in the mediastinum. This may result in such complications as superior vena cava syndrome or pulmonary edema from compression of pulmonary veins.

Treatment for chronic fibrosing mediastinitis is somewhat controversial, and may include steroids or surgical decompression of affected vessels.

External links

-6684651 at GPnotebook
Mediastinitis at the US National Library of Medicine Medical Subject Headings (MeSH)
Fibrosing Mediastinitis
Fibrosing Mediastinitis Jason's Site
Tami Jo's Site on FM
Mediastinal Germ Cell Tumors

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English Journal

Fibrosing mediastinitis: an unusual cause of pulmonary symptoms.

Schade MA, Mirani NM.SourceDepartment of Internal Medicine, UMDNJ-NJMS, Newark, NJ, USA, schademe@umdnj.edu.
Journal of general internal medicine.J Gen Intern Med.2013 Dec;28(12):1677-81. doi: 10.1007/s11606-013-2528-8. Epub 2013 Jun 27.
Fibrosing mediastinitis (FM), also known as granulomatous or sclerosing mediastinitis, is an uncommon but serious cause of chest symptoms. Due to an infectious or inflammatory challenge, production of collagen occurs in the confined space of the mediastinum. Collagen formation leads to compression o
PMID 23807725

The frozen elephant trunk technique for retrograde acute type A aortic dissection.

Tamura K, Uchida N, Katayama A, Sutoh M, Kuraoka M, Sueda T.SourceDivision of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan. Electronic address: tamuken0801@yahoo.co.jp.
The Journal of thoracic and cardiovascular surgery.J Thorac Cardiovasc Surg.2013 Nov 16. pii: S0022-5223(13)01260-9. doi: 10.1016/j.jtcvs.2012.12.094. [Epub ahead of print]
OBJECTIVE: The operative strategies for retrograde acute type A aortic dissection with a primary intimal tear remain controversial because resection of an intimal tear via a median sternotomy is difficult. We evaluated the frozen elephant trunk technique for treating this type of aortic dissection.M
PMID 24252940

Ventricular Septal Defect Complicated by Infantile Lobar Emphysema.

Nakata T, Ikeda T, Date H, Doi H, Baba S, Hirata T, Sakata R.SourceDepartment of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia.Ann Thorac Cardiovasc Surg.2013 Nov 8. [Epub ahead of print]
An infant with ventricular septal defect, atrial septal defect, and Down syndrome (trisomy 21) was referred to our institution. The patient gradually developed infantile lobar emphysema of the right upper lobe and became dependent on mechanical ventilator support. When the patient was five months of
PMID 24200662

Japanese Journal

症例大網充塡術後の再開胸で弁置換術を行った1例

安達晃一,山口敦司,由利康一 [他]
胸部外科 = The Japanese journal of thoracic surgery 68(2), 129-132, 2015-02
NAID 40020333743

縦隔炎・胸骨骨髄炎における陰圧閉鎖療法の実際 (特集陰圧閉鎖療法の理論と実際)

榊原俊介,寺師浩人,岡田健次
Pepars (97), 64-71, 2015-01
NAID 40020379683

食道破裂・穿孔の検討

松谷毅,野村務,萩原信敏,牧野浩司,丸山弘,宮下正夫,内田英二
日本腹部救急医学会雑誌 35(1), 061-065, 2015
（目的）当科における食道破裂・穿孔症例の診断，治療と転帰を検討する。（対象）2003～2013年までの食道破裂・穿孔15例（特発性4例，医原性11例）を対象とした。（結果）特発性の縦隔内限局型2例は保存的治療を，胸腔内穿破型2例は手術療法を行った。食道アカラシアおよび食道狭窄のバルーン拡張術，内視鏡的逆行性胆管膵管造影用の内視鏡ファイバー，咽頭部通過用のガイドチューブ，食道癌に対する粘膜剥離術など …
NAID 130005069724