Mediastinitis

Mediastinitis is swelling and irritation (inflammation) of the chest area between the lungs (mediastinum). This area contains the heart, large blood vessels, windpipe (trachea), food tube (esophagus), thymus gland, lymph nodes, and connective tissue.

Mediastinitis usually results from an infection. It may occur suddenly (acute), or it may develop slowly and get worse over time (chronic). It most often occurs in people who recently had an upper gastrointestinal (GI) endoscopy (EGD) or chest surgery.

A person may have a tear in their esophagus that causes mediastinitis. Causes of the tear include:

• A procedure such as upper GI endoscopy
• Forceful or constant vomiting
• Trauma

Other causes of mediastinitis include:

• Fungal infections (histoplasmosis)
• Radiation to the chest
• Inflammation of the lymph nodes, lungs, liver, eyes, skin, or other tissues (sarcoidosis)
• Bacterial infections (anthrax, tuberculosis)
• Cancer (such as lung cancer or lymphoma)
• Severe dental infection spreading into chest (descending mediastinitis)

Risk factors include:

• Chronic obstructive pulmonary disease (COPD)
• Disease of the esophagus
• Diabetes mellitus
• Kidney failure
• Obesity
• Problems in the upper gastrointestinal tract
• Recent chest surgery or upper GI endoscopy
• Weakened immune system

Symptoms may include:

• Chest pain
• Chills
• Fever
• General discomfort
• Shortness of breath

Signs of mediastinitis in people who have had recent surgery include:

• Chest wall tenderness
• Wound drainage
• Sensation of air trapped under the skin

Your health care provider will perform a physical exam and ask about your symptoms and medical history.

Tests may include:

• Chest CT scan or MRI scan
• Chest x-ray
• Ultrasound

Your provider may insert a needle into the area of inflammation. This is to obtain a sample to send for a Gram stain, other stains, and culture to determine the type of infection, if present.

You may receive antibiotics if you have an infection.

You may need surgery to drain the area of inflammation if the blood vessels, windpipe, or esophagus are affected.

How well a person does depends on the cause and severity of the mediastinitis.

Mediastinitis after chest surgery or injury is very serious. There is a risk of dying from this condition if it isn't identified quickly and treated.

Complications include the following:

• Spread of the infection to the bloodstream, blood vessels, bones, heart, or lungs
• Scarring

Scarring can be severe, especially when it is caused by chronic mediastinitis. Scarring can interfere with heart or lung function.

Contact your provider if you have had chest surgery or trauma and develop:

• Chest pain
• Chills
• Drainage from the wound
• Fever
• Shortness of breath

If you have a lung infection, cancer, or sarcoidosis and develop any of these symptoms, contact your provider right away.

To lessen the risk of developing mediastinitis related to chest surgery, surgical wounds should be kept clean and dry after surgery.

Treating tuberculosis, sarcoidosis, dental infections, or other conditions associated with mediastinitis may prevent this complication.

Lentz RJ, Loyd JE. Mediastinitis and fibrosing mediastinitis. In: Broaddus VC, Ernst JD, King TE, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 116.

Ryder JH, Van Schooneveld TC, Rupp ME. Mediastinitis. In: Blaser MJ, Cohen JI, Holland SM, et al, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 10th ed. Philadelphia, PA: Elsevier; 2026:chap 87.

Last reviewed on: 8/29/2024

Jatin M. Vyas, MD, PhD, Roy and Diana Vagelos Professor in Medicine, Columbia University Vagelos College of Physicians and Surgeons, Division of Infectious Diseases, Department of Medicine, New York, NY. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.