Chapter 17 Diffuse Mediastinal Abnormalities
DIFFUSE MEDIASTINAL ABNORMALITIES
Mediastinitis
Acute Mediastinitis
Box 17-1 Causes of Acute Mediastinitis
ESOPHAGEAL PERFORATION
Iatrogenic (after esophagoscopy or esophageal dilation)
Impacted foreign body (chicken bone, sharp objects)
Obstructing esophageal neoplasm
Trauma (penetrating trauma more than blunt trauma)
EXTENSION OF INFECTION FROM ADJACENT SPACES
Pharynx (retropharyngeal or nasopharyngeal abscess)
Retroperitoneum (pancreatic pseudocyst)
Esophageal Perforation
Chest radiographic findings include diffuse widening of the mediastinum and pneumomediastinum (Fig. 17-3). Associated pleural abnormalities are usually left sided and include pneumothorax and empyema. When the diagnosis is delayed, complications may include mediastinal abscess formation and rupture of the abscess into the adjacent bronchus (i.e., esophagobronchial fistula) and pleura (i.e., esophagopleural fistula, often with subsequent development of empyema). The diagnosis of esophageal perforation can be confirmed by fluoroscopic examination after administration of water-soluble contrast, which demonstrates extravasation of contrast at the site of perforation (Fig. 17-4). In complicated cases that have progressed to mediastinal abscess formation, CT may be helpful in identifying the precise location and extent of fluid collections (Fig. 17-5).
