Chronic Mediastinitis
Key Points
- Chronic mediastinitis is most commonly associated with fungal or mycobacterial infections and encompasses a spectrum of inflammation from a chronic granulomatous process to dense fibrosis.
- The inflammatory process can cause focal or diffuse encroachment or occlusion of mediastinal structures.
- Symptoms of chronic mediastinitis are secondary to the compromised structure(s).
- Medical therapy with antifungal therapy or anti-inflammatory agents such as steroids have been reported to have variable beneficial therapeutic effects in reversing or resolving the inflammatory process.
- Surgery often plays a role in establishing a diagnosis, as distinguishing the benign chronic mediastinitis process from a neoplastic or malignant process by clinical and radiographic features alone can be difficult.
- Both surgical and endovascular therapies can be required to palliate symptoms due to significantly compressed organs.
- Therapy with the anti B-lymphocyte agent rituximab has also shown promise in terms of clinical and radiographic responses and can be discussed in a multi-disciplinary setting for symptomatic patients as an adjunct or alternative to an invasive procedure.
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Last updated: January 13, 2023
Citation
Berry, Mark. "Chronic Mediastinitis." Pearson's General Thoracic Surgery. STS Cardiothoracic Surgery E-Book, Chicago: Society of Thoracic Surgeons, 2023. STS Surgery, ebook.sts.org.
Berry M. Chronic Mediastinitis. In: Darling GE, Baumgartner WA, Jacobs JP, eds. Pearson's General Thoracic Surgery. STS Cardiothoracic Surgery E-Book. Chicago: Society of Thoracic Surgeons; 2023. ebook.sts.org. Accessed September 27, 2023.
Berry, M. (2023). Chronic Mediastinitis. In Darling, G., Baumgartner, W., & Jacobs, J. (Eds.), Pearson's General Thoracic Surgery. STS Cardiothoracic Surgery E-Book. Chicago: Society of Thoracic Surgeons. ebook.sts.org
Berry M. Chronic Mediastinitis [Internet]. In: Darling GE, Baumgartner WA, Jacobs JP, editors. Pearson's General Thoracic Surgery. STS Cardiothoracic Surgery E-Book. Chicago: Society of Thoracic Surgeons; 2023. [cited 2023 September 27]. Available from: ebook.sts.org.
* Article titles in AMA citation format should be in sentence-case
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T1 - Chronic Mediastinitis
ID - 1418304
ED - Jacobs,J,
ED - Darling,Gail,
ED - Baumgartner,William,
Y1 - 2023/01/13/
BT - Pearson's General Thoracic
UR - https://ebook.sts.org/sts/view/Pearsons-General-Thoracic/1418304/all/Chronic_Mediastinitis
PB - Chicago: Society of Thoracic Surgeons
DB - STS Surgery
DP - Unbound Medicine
ER -