Primary mediastinal infection

Introduction to primary mediastinal infection Primary mediastinal infection is clinically a less accurate diagnosis. A small number of cases are converted from acute mediastinal infection. The primary mediastinal infection is caused by fungi, histoplasmosis, tuberculosis, tuberculosis and other causes. Mediastinal lymphadenopathy has been considered as a specific cause, and lymphadenopathy appears clinically. After the acute inflammation subsides, the lymph nodes become fibrotic and contract to become chronic infection. The so-called primary mediastinal fibrous tissue infection often refers to the process of non-specific, diffuse and dense connective tissue fibrosis of unknown cause, also known as idiopathic fibrosing mediastinitis, which can invade a whole mediastinum or a part of the mediastinum. Ventricular stenosis caused by mediastinal fibrous tissue is one of the evidences of lymphatic infection. basic knowledge The proportion of illness: 0.002% Susceptible people: no special people Mode of infection: non-infectious Complications: perforation of the esophagus, pleural effusion, mediastinal emphysema, mediastinal abscess

Primary mediastinal infection

Primary mediastinal infections can be divided into three types:

(1) granulomatous form :

It is mainly caused by histoplasmosis and tuberculosis. It is formed by cavernous necrosis and abscess of the lymph nodes, and then spreads into the mediastinum. It is confined to the invading lymph nodes in the connective tissue and can also erode to adjacent structures. The infection is limited to the right. In the parabronchial or tracheobronchial lymph nodes, the superior vena cava obstruction can be produced, and the subcarinal lymph nodes are invaded, which can affect the anterior wall of the esophagus. Once the lymph nodes are perforated to the esophagus, the traction diverticulum is caused. When the granuloma invades the esophageal ring, it can cause stenosis and infection. Dissemination along the bronchus produces bronchiectasis, and it is rare to erode the trachea alone. However, children's tuberculous lymph nodes can penetrate the trachea and cause obstruction.

Granulomatous mediastinal infections can occasionally be caused by fungi, such as actinomycosis, nocardiosis, blastomycosis, and mucormycosis, which can be directly invaded by the lungs into the mediastinum. Then do not go through the intermediate lymph node pathway.

(2) Localized fibrous form :

No obvious granuloma mass is expressed as advanced granulomatous lesions. Most of the causes are histoplasmosis and tuberculosis. Some of the causes are unknown. This type causes upper vena cava obstruction, tracheal deformation is narrow, and pulmonary or pulmonary vein stenosis can be complicated. Pericarditis.

Under normal conditions, the aorta and left main bronchus, the esophagus is loose connective tissue, the two can move independently, but in the case of fibrous mediastinal inflammation, the tissue adheres to each other, when the esophageal barium meal is examined for swallowing action, the aortic arch and The trachea can be raised together, the so-called aortic swallowing sign, localized fibrotic mediastinal inflammation with conjunctival and constrictive pericarditis, except for tuberculosis and other diseases, most of the etiology is unknown, bronchoconstriction is also this type of mediastinum Common complications of infection.

(3) Chronic abscess (chronic abscess) :

Chronic mediastinal abscess due to chronic mediastinal lymph node infection, acute mediastinal abscess drainage, bronchospasm, esophageal fistula, etc., chronic abscess from lymph nodes or spine often tuberculosis, bronchospasm, esophageal fistula often as a surgical complication, secondary Sexual mediastinal infection.

Chronic mediastinal abscess is almost indistinguishable from local granulomas and fibrotic mediastinal inflammation, unless communicating with the esophagus or bronchus, fluid leveling in the mediastinum or suggesting communication with the esophagus, which proves that the abscess is caused by esophageal rupture, but it may also be that the abscess breaks into the esophagus. Inside.

Primary mediastinal infection causes mediastinal contraction, so X-ray film can not find abnormalities, the most serious mediastinal fibrosis can involve the superior vena cava, resulting in superior vena cava obstruction, if there is chronic abscess, according to the location of the lesion and The range produces a variety of symptoms, such as pain, fever, difficulty in swallowing, anemia, persistent white blood cell rise, weight loss, and even cachexia. Chronic dry cough may also be a symptom caused by the expansion of the mediastinal lesion to the lungs, causing the patient to be chronically infected for a long time. The state, the oppression of the abscess, the fibers of the tissue, causing compression and destruction of the organs in the mediastinum, resulting in corresponding symptoms.

Primary mediastinal infection prevention

Supportive therapy, strengthen nutrition, improve their own resistance, anti-infection, primary mediastinal abscess to eradicate the disease because of the main, venous obstruction, compression of the superior vena cava syndrome, pericarditis requires surgery.

When it is clear that the patient has a mediastinal infection, the cause should be actively searched for the pathogen causing the mediastinal infection, and then the corresponding sensitive antibiotics should be given according to different bacteria.

Primary mediastinal infection complications Complications, esophageal perforation, pleural effusion, mediastinal emphysema, mediastinal abscess

Mediastinal infection can cause mediastinal fibrosis, the most serious mediastinal fibrosis can involve the superior vena cava, resulting in superior vena cava obstruction.

The mediastinum has fat, rich lymph and loose connective tissue. After infection, it is easy to spread. The mediastinal infection caused by perforation of esophagus often involves pleural effusion. It is more common on the left side and rapidly develops into empyema. Air into the mediastinum can be complicated by mediastinal emphysema or pneumothorax, and the mediastinal abscess can also directly break into the esophagus, bronchus or pleural cavity.

Primary mediastinal infection symptoms common symptoms hypothermia weakness cachexia pulmonary artery stenosis calcification tracheal tracheal shift ventricular hypertrophy

1. Early diagnosis of primary mediastinal infection is difficult. The general symptoms include chest pain, low fever, general weakness, weight loss, cough, sludge symptoms of chronic disease, and even development of cachexia. The test may find a decrease in hemoglobin. White blood cells continue to rise, no abnormalities can be found in the early X-ray film. When a localized granulomatous mediastinal infection is found, local mediastinum is widened on the X-ray film. The most common X-ray findings are right tracheal masses with sternum. The posterior gap density increased. The lesions were composed of granuloma masses, inflammatory lymph nodes, and fibrous tissue. The similar masses in the subcarinal area were most easily seen in the lateral position and oblique letter, such as the mediastinal space after infection and erosion.

2, invading the esophageal stenosis, the esophageal angiography showed limited marginal margins, the observation of the subcarinal mass from the posterior anterior chest radiograph is only the upper density of the heart shadow is increased, the large mass causes the bilateral main bronchus to shift, the tracheal bulge The angle of the fork is widened, and the contour of the mass is not very clear. If the center of the mass is necrotic or dry, it is easy to be calcified. The contour of the calcification is irregular. The tomography (CT) can show that the localized fibrous deformity X-ray Diagnosis, the X-ray image of an organ in the mediastinum is prominent, especially in the superior vena cava syndrome, the upper right mediastinum is widened. When the obstruction is below the entrance of the superior vena cava, the superior vena cava becomes the main collateral pathway. Expanded, showing local expansion at the right bronchial angle, pulmonary stenosis showed less blood supply to the lung field and right ventricular hypertrophy, pulmonary vein stenosis due to reflux disorder and lung field congestion, extensive fibrous mediastinal infection, mediastinal hardening, sharp edges, loss of normal music Degree, bilateral mediastinum becomes hard and rough, such as chronic mediastinal abscess secondary to vertebral body infection, lumps shadowing bilateral mediastinum, caused by bone tuberculosis Spacer abscess often visible on X-ray film.

Primary mediastinal infection

1. No abnormalities can be found in the early X-ray film. When a localized granuloma-type mediastinal infection is found, the local mediastinum is widened on the X-ray film. The most common X-ray findings are the right tracheal mass and the sternal posterior space density. Increased, the lesions are caused by granuloma mass, inflammatory lymphatics, fibrous tissue mixing, similar masses in the subcarinal area are most visible in the lateral position and oblique letter, such as the mediastinal space after infection and erosion.

2, invading the esophageal stenosis, the esophageal angiography showed limited marginal margins, the observation of the subcarinal mass from the posterior anterior chest radiograph is only the upper density of the heart shadow is increased, the large mass causes the bilateral main bronchus to shift, the tracheal bulge The angle of the fork is widened, and the contour of the mass is not very clear. If the center of the mass is necrotic or dry, it is easy to be calcified. The contour of the calcification is irregular. The tomography (CT) can show that the localized fibrous deformity X-ray Diagnosis, the X-ray image of an organ in the mediastinum is prominent, especially in the superior vena cava syndrome, the upper right mediastinum is widened.

Diagnosis and diagnosis of primary mediastinal infection

Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.

Differential diagnosis

Mainly differentiated from primary mediastinal tumors, because when the tumor occurs in the mediastinum, it is easy to merge infection, and strict distinction is needed to avoid delay in treatment.

The main symptoms of mediastinal tumors are as follows:

(1) respiratory symptoms: chest tightness, chest pain usually occurs in the back of the sternum or the side of the chest, most malignant tumors invade the bones or nerves, the pain is severe, cough is often caused by pressure of the trachea or lung tissue, hemoptysis is less common.

(2) symptoms of the nervous system: due to tumor compression or erosion of the nerve to produce various symptoms: such as tumor invasion can cause hoarseness, can produce chest pain or paresthesia, causing limb paralysis.

(3) Symptoms of infection: If the cyst is broken or the tumor infection affects the bronchial or lung tissue, a series of infection symptoms appear.

(4) symptoms of compression: esophagus, tracheal compression, there may be symptoms such as shortness of breath or hypopharyngeal obstruction.

(5) Special symptoms: The patient coughs up sebum and hair.

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