Acute Mediastinitis Research Articles

Continuous Quality Improvement Program and Major Morbidity After Cardiac Surgery

The aim of this study was to investigate how a continuous quality improvement (CQI) program affected major morbidity and postoperative outcomes after cardiac surgery. Patients were divided into 2 groups: those who underwent surgery (coronary artery bypass grafting, isolated valve surgery, or coronary artery bypass grafting and valve surgery) after the establishment of a CQI program (from January 2005 to December 2006, n = 922) and those who underwent surgery beforehand (from January 2002 to December 2003, n = 1,289). Patients who had surgery in 2004, when the system and processes were reengineered, were not included in the analysis. Outcomes compared between the 2 groups included (1) acute renal failure, (2) stroke, (3) sepsis, (4) hemorrhage-related reexploration, (5) cardiac tamponade, (6) mediastinitis, and (7) prolonged length of stay. Logistic regression analysis and propensity score adjustment were used to adjust for imbalances in the patients' preoperative characteristics. After propensity score adjustment, CQI was found to decrease the rate of sepsis (odds ratio [OR] 0.5, 95% confidence interval [CI] 0.3 to 0.9, p = 0.02) and cardiac tamponade (OR 0.2, 95% CI 0.04 to 0.8, p = 0.02) but to only marginally decrease the rate of acute renal failure (OR 0.7, 95% CI 0.5 to 1.0, p = 0.07). CQI did not emerge as an independent risk factor for hemorrhage-related reexploration, prolonged length of stay, mediastinitis, or stroke in either multivariate logistic regression analysis or propensity score adjustment. In conclusion, the systematic implementation of a CQI program and the application of multidisciplinary protocols decrease sepsis and cardiac tamponade after cardiac surgery.

Utility of Omentoplasty for Poststernotomy Mediastinitis Secondary to Myocardial Revascularization Surgery

Acute poststernotomy mediastinitis is a serious complication of cardiac surgery and is associated with high mortality. Conservative treatment with local debridement, irrigating-suction systems, and specific antibiotic therapy is sometimes inadequate. Omentoplasty is occasionally used for reconstruction and the treatment of various chest diseases. This useful procedure is most often indicated for suppurative processes and radionecrosis, to complement myoplasty, or to cover a chest wall prosthesis. When used to treat poststernotomy mediastinitis secondary to cardiac surgery, omentoplasty improves control of infection and prognosis. We describe 2 cases of poststernotomy mediastinitis secondary to cardiac revascularization surgery in which omentoplasty was an effective treatment. Excellent control of infection was achieved.

L'oxygénothérapie hyperbare comme adjuvant pour le traitement d'une médiastinite aiguë par perforation œsophagienne: à propos d'un cas

In spite of antibiotic treatment, of progress of resuscitation and surgery, acute posterior mediastinitis remains associated to a high mortality. We report a case of man with posterior mediastinitis by performing of the cervical oesophagus. While his state remained still with the classic treatment, the contribution of the hyperbaric oxygen therapy quickly improved his state. This therapeutics in addition in the usual treatment could improve the survival in this affection.

Case 121

HomeRadiologyVol. 243, No. 2 PreviousNext Diagnosis PleaseCase 121Timothy D. Watson, Shital J. Patel, Peter M. NardiTimothy D. Watson, Shital J. Patel, Peter M. NardiAuthor Affiliations1From the Department of Radiology, Long Island College Hospital, 339 Hicks St, Brooklyn, NY 11201. Received September 1, 2004; revision requested November 10; revision received December 16; accepted January 20, 2005; final version accepted March 2.Address correspondence to T.D.W. (e-mail: [email protected]).Timothy D. WatsonShital J. PatelPeter M. NardiPublished Online:May 1 2007https://doi.org/10.1148/radiol.2432041498MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Article HistoryPublished in print: 2007 FiguresReferencesRelatedDetailsRecommended Articles Sequelae of Eating Disorders at ImagingRadioGraphics2022Volume: 42Issue: 5pp. 1377-1397Iodixanol versus Iopromide at Coronary CT Angiography: Lumen Opacification and Effect on Heart Rhythm—the Randomized IsoCOR TrialRadiology2017Volume: 286Issue: 1pp. 71-80Multimodality Imaging of Focal and Diffuse Fibrosing MediastinitisRadioGraphics2019Volume: 39Issue: 3pp. 651-667Stratification, Imaging, and Management of Acute Massive and Submassive Pulmonary EmbolismRadiology2017Volume: 284Issue: 1pp. 5-24Virtual Hepatic Venous Pressure Gradient with CT Angiography (CHESS 1601): A Prospective Multicenter Study for the Noninvasive Diagnosis of Portal HypertensionRadiology2018Volume: 290Issue: 2pp. 370-377See More RSNA Education Exhibits The Barcode for Diagnosing Mediastinal Pathologies: From Lines and Stripes on the Chest X-ray to the Anatomical PathologyDigital Posters2020Diagnosing Acute Mediastinitis in the ER: A Life-Threatening RiddleDigital Posters2019Acute Pulmonary Embolism: The Role of the Radiologist from Diagnosis to TreatmentDigital Posters2018 RSNA Case Collection Horner syndrome in neuroblastomaRSNA Case Collection2020Tracheal bronchusRSNA Case Collection2021Post-operative intra-abdominal abscess RSNA Case Collection2020 Vol. 243, No. 2 Metrics Altmetric Score PDF download

Clinical Analysis of Esophageal Foreign Body in Jeju

Purpose: The esophageal foreign body results from ingestion of various materials and some foreign bodies such as fish bone can make severe complications such as esophageal perforation and acute mediastinitis. The purposes of this study were to investigate the clinical characterisitcs of esophageal foreign body in Jeju and to analyze the complicated cases by esophageal foreign body.Methods: A total 32 patients who were treated for foreign body in gastrointestinal tract at Cheju National University Hospital from May 2003 to October 2006 were reviewed retrospectively. The review about clinical informations included patient's age, sex, chief complains, presentation time from symptom, duration of admission, endoscopic treatment, and complications. The length and type of foreign body also were reviewed. Complicated group and non-complicated group were compared in aspect of probability of complications in esophageal foreign body.Results: Male was 65.6% and pediatric under 15 years old was 40.6%. The mean age was 35.53±25.98 years old and the mean presentation time from symptom was 27.98±53.95 hours. Dysphagia and foreign body sense was major chief complain in adults and most pediatric had no symptom. Most foreign body were located in esophagus and the mean size of foreign body was 2.34±1.06 cm. The most common foreign body was fish bone and 35.7% among fish bone injuries had complication such as esophageal perforation and acute mediastinitis. Compared with non-complicated group, complicated group was older and had longer presentation time from symptom and more chest pain as chief complains significantly.Conclusion: The most esophageal foreign body in Jeju was fish bone, that made more complications than the other areas. Older patient with esophageal fish bone who presented later and had chest pain could be supposed to have complications by fish bone.

Off-pump CABG in diabetic patients: Does insulin dependency matter?

Background. We aimed to analyze influence of insulin dependency on short-term outcomes after OPCAB in patients with diabetes. Methods. Retrospective cohort study was planned based on chart review. Study population consisted of 148 diabetic cases (63 insulin-dependent diabetics in group I and 85 non-insulin-dependent diabetics in group II). Patients’ preoperative data and risk factors for adverse outcomes are analysed. The primary endpoint was all causes of mortality during the in-hospital course. Preestablished secondary endpoints included all major postoperative complications, including non-fatal acute myocardial infarction, non-fatal stroke, sepsis, shock, mediastinitis, respiratory insufficiency, and renal insufficiency, and minor postoperative complications, including mechanical ventilation for more than 24 hours, inotropic support, reoperation for bleeding, and necessity of blood transfusion. Additional analysis was performed on the duration of stay in the intensive care unit and overall hospital stay. Results. Group I patients were significantly more likely to have hypertension (87.3% versus 82.5%, p=0.023), they also had a trend toward higher prevalence of hypercholesterolemia (71.4% versus 68.6%, p=0.092) and body mass index (28.1±4.2 versus 26.9±3.7, p=0.085). Angiographic characteristics and number of distal anostomosis were similar in the two groups. There was no significant difference in mortality during the in-hospital course as the primary endpoint. However, analysis in secondary endpoints revealed that group I patients were significantly more likely to have stroke (3.1% versus 2.3%, p=0.027), sternal wound infection (4.7% versus 3.4%, p=0.036) and atrial arrhythmia (28.3% versus 20.9%, p=0.021). Moreover, group I patients were significantly more likely to stay longer than 2 days in ICU (14.2% versus 11.6%, p=0.038). Higher prevalence of renal dysfunction was also observed in group I patients (7.9% versus 6.9%, p=0.069). Conclusion. Similar to insulin dependent diabetes who had on-pump CABG, insulin dependant diabetes develop higher rate of major postoperative complications and stay longer in ICU after off-pump CABG.

Mediastinitis and bilateral pleural empyema caused by an odontogenic infection

Mediastinitis and bilateral pleural empyema caused by an odontogenic infectionBackground. Although odontogenic infections are relatively frequent in the general population, intrathoracic dissemination is a rare complication. Acute purulent mediastinitis, known as descending necrotizing mediastinitis (DNM), causes high mortality rate, even up to 40%, despite high efficacy of antibiotic therapy and surgical interventions. In rare cases, unilateral or bilateral pleural empyema develops as a complication of DNM.Case report. This case report presents the treatment of a young, previously healthy patient with mediastinitis and bilateral pleural empyema caused by an odontogenic infection. After a neck and pharynx re-incision, and as CT confirmed propagation of the abscess to the thorax, thoracotomy was performed followed by CT-controlled thoracic drainage with continued antibiotic therapy. The patient was cured, although the recognition of these complications was relatively delayed.Conclusions. Early diagnosis of DNM can save the patient, so if this severe complication is suspected, thoracic CT should be performed.

Spontaneous Acute Mediastinitis Secondary to Rupture Esophageal Diverticula in Patient with Esophageal Diverticulosis

We are presenting a patient who had spontaneous perforation of esophageal diverticulosis with limited mediastinitis. The patient is a 45-year-old white male who presented with fever, hypoxemia, and chest pain. He was in a good state of health until one month before presentation, when he developed solid food dysphagia. with emesis (On one occasion). Three days prior to presentation he developed right sided chest pain, with radiation to back. The pain worsened, and became associated with SOB. CT was negative for PE. The patient's pain intensified further, requiring him to be transferred to our hospital. Upon arrival he exhibited the following signs and symptoms: fever, chest discomfort, red throat, and decreased breath sounds to auscultation on the right. Remainder of PE was negative. Repeat CT of the chest with contrast showed air in the mediastinum but no contrast leak. Patient was started on broad spectrum antibiotics, esophagram with gastrografin and barium showed no extra-luminal leak but multiple diverticula in the esophgeal wall (Figure 1). Patient underwent thoracentesis with removal of inflammatory fluid.Patient was placed on liquid diet and he continues to improve with conservative therapy and he was discharged home. Endoscopy 6 weeks later confirmed the presence of the diverticulosis (Figure 2). The patient remained symptoms free 4 month after inital presenattion. Diffuse intramural esophageal diverticulosis is a rare entity that was first described in 1960. Multiple cases have been reported, most of them presenting with Dysphagia, this case is unique because the initial presentation was with mediastinitis and the patient was treated conservatively with good result. [figure 1][figure 2]Figure 1Figure 2

Emergency subtotal oesophagectomy.

From 1981 to 1987 nine patients have undergone resection and reconstruction of the oesophagus as an emergency, using a two-part left-sided approach with oesophagogastric anastomosis in the neck. Five patients had oesophageal perforation with a carcinoma; one had spontaneous perforation of an intrathoracic stomach; two had severe haemorrhage; and one had acute sterile mediastinitis. Following operation there was one postoperative death (11 per cent) and no major complications. Long-term survival was marred only by the development of further malignancy in four patients. Subtotal oesophagectomy has both theoretical and practical advantages over conventional oesophagogastrectomy in oesophageal emergencies and we suggest that it should be considered as the method of choice in the management of these difficult cases.

Acute mediastinitis after cardiac operations – 10 years experience

From April 1995 until July 2004 in our department we treated 26 patients with 15 days post.-Op. acute mediastinitis after midline sternotomy for cardiac operation. We present our technique and our results in this serious complications after cardiac operation.

Acute poststernotomy mediastinitis managed with debridement and closed-drainage aspiration: Factors associated with death in the intensive care unit

The purpose of the study is to describe an intensive care unit's experience in the treatment of poststernotomy mediastinitis and to identify factors associated with intensive care unit death. Over a 10-year period, 316 consecutive patients with mediastinitis occurring less than 30 days after sternotomy were treated in a single unit. First-line therapy was closed-drainage aspiration with Redon catheters. Variables recorded, including patient demographics, underlying disease classification, clinical and biologic data available at intensive care unit admission and day 3, and their association with intensive care unit mortality, were subjected to multivariate analyses. Intensive care unit mortality (20.3%) was significantly associated with 5 variables available at admission: age greater than 70 years (odds ratio, 2.70), operation other than coronary artery bypass grafting alone (odds ratio, 2.59), McCabe class 2/3 (odds ratio, 2.47), APACHE II score (odds ratio, 1.12 per point), and organ failure (odds ratio, 2.07). After introducing day 3 variables into the logistic regression model, independent risk factors for intensive care unit death were as follows: age greater than 70 years, operations other than coronary artery bypass grafting alone, McCabe class 2/3, APACHE II score, mechanical ventilation still required on day 3, and persistently positive bacteremia. For patients receiving mechanical ventilation for less than 3 days, mortality was very low (2.4%). In contrast, for patients receiving mechanical ventilation for 3 days or longer, mortality reached 52.8% and was associated with non-coronary artery bypass grafting cardiac surgery, persistently positive bacteremia, and underlying disease. In patients requiring intensive care for acute poststernotomy mediastinitis, age, type of cardiac surgery, underlying disease, and severity of illness at the time of intensive care unit admission were associated with intensive care unit death. Two additional factors (mechanical ventilation dependence and persistently positive bacteremia) were identified when the analyses were repeated with inclusion of day 3 patient characteristics.

Acute mediastinitis: spectrum of computed tomography findings

The objective of this study was to describe CT findings and to determine the diagnostic value of CT in diagnosis of acute mediastinitis. CT findings were retrospectively studied in 40 patients with suspected acute mediastinitis, including 28 postoperative patients, five with acute descending necrotizing mediastinitis (ADNM), and seven with suspected post-traumatic perforation of the esophagus. Findings included increased attenuation of mediastinal fat (100%), localized mediastinal fluid collections (55%), free gas bubbles in the mediastinum (57.5%), mediastinal lymph nodes (35%), pericardial effusions (27.5%), pleural effusions (85%), lung infiltrates (35%), sternal dehiscence (40%), and pleuromediastinal fistula (2.5%). The sensitivity and specificity of CT in postoperative patients in the first 17 days was 100% and 33% respectively, and after day 17, 100% and 90%. In patients with ADNM sensitivity was 100% while in patients with suspected esophageal perforation sensitivity and specificity were 100%. CT is a highly sensitive technique for the detection of mediastinitis of various causes. For the postoperative patients there is clear time dependence for CT interpretation and accuracy. In patients with suspected ADNM, and traumatic esophageal perforation CT is highly specific early after clinical presentation.

Acute mediastinitis resulting from an unsuspected fish bone - case report

Acute mediastinitis is a serious medical condition with a mortality rate from 30 to 40% or even higher. Early diagnosis with prompt and aggressive treatment is essential to prevent its rapid progression. Severe odynophagia and respiratory distress with positive neck or chest findings should raise suspicion of mediastinitis. We report a rare case of acute mediastinitis secondary to the unexpected migration of an impacted fish bone from the esophagus.

Critical care transesophageal endosonography and guided fine-needle aspiration for diagnosis and management of posterior mediastinitis.

Acute mediastinitis is a serious complication; it occurs after esophageal perforation and thoracic surgery and is rarely due to infections. Clinical and computed tomographic scan signs may be nonspecific, especially in postoperative patients. We prospectively evaluated the value of transesophageal endosonography with guided fine-needle aspiration in the diagnosis and identification of etiologic agents in critically ill patients with suspected posterior mediastinitis. University hospital. Transesophageal endosonography/fine-needle aspiration was performed at the bedside in the intensive care unit with a Pentax 34UX echo-endoscope and a portable Hitachi console (EUB 525). Eighteen patients with clinically suspected mediastinitis were examined with intensive care team support. Computed tomography was performed before transesophageal endosonography in all 18 patients and was inconclusive in 9. Transesophageal endosonography detected mediastinal lesions in 16 (89%) of 18 patients and was more accurately diagnostic than computed tomography (p =.0082). Fifteen patients had undergone surgery (11 esophagectomy, 1 other esophageal surgery, 1 head/neck cancer surgery, 1 complication after dilatational tracheostomy, and 1 with intervention after polytrauma). Three patients were suspected to have nonpostoperative mediastinitis. In 16 patients, infectious organisms were detected (bacterial, n = 14; fungal, n = 1; tuberculosis, n = 1). Culture and sensitivity of transesophageal endosonography/fine-needle aspiration specimens led to appropriate drug therapy. In two patients, methicillin-resistant Staphylococcus aureus was detected, leading to isolation care. Twelve patients improved; six died. Of the two patients in whom transesophageal endosonography did not detect a mediastinitis, one was false negative on autopsy. There were no complications. Bedside transesophageal endosonography/fine-needle aspiration of posterior mediastinal lesions in critically ill patients was an effective and relatively noninvasive way to detect mediastinitis and provide material to identify the etiologic agent. It was particularly useful in postesophagectomy patients.

A Case of Traumatic Acute Pericarditis Mimicking Acute Myocardial Infarction, Caused by Swallowing Fishhook

A patient, with severe chest pain and isolated ST segment elevation, was evaluated in order to differentiate ischemic heart disease, such as acute myocardial infarction. A fishhook was incidentally found during coronary angiography, chest CT and esophagoscopy. With this information, the patient was re-interviewed, and it was learned that the patient had swallowed the fishhook from cooked fish after fishing trip. The patient was diagnosed as traumatic acute pericarditis with acute mediastinitis, associated with esophageal and pericardial perforation. The patient was successfully treated by surgical treatment drainage and adequate antibiotic use. We report a case of traumatic acute pericarditis, which mimicked an acute myocardial infarction, with a review of the literature. (Korean Circulation J 2003;33 (9):821-826)

Análisis descriptivo de una serie de casos diagnosticados de mediastinitis aguda

Acute mediastinitis is one of the most aggressive chest diseases. The mortality rate ranges between 14% and 42%. We present a retrospective analysis of a series of 26 cases (20 men and 6 women) treated between January 1994 and March 2002 and review the literature. Mediastinitis originated in the esophagus in 17 patients (8 postoperative, 4 due to iatrogenic perforation, 4 due to noniatrogenic perforation, and 1 due to a foreign body) and in the oropharynx in 6 patients; mediastinitis was secondary to median sternotomy in 3. Twenty-five patients were treated surgically. In addition to radical debridement and drainage, which were carried out on all the patients, 10 also underwent esophagectomy or resection of the esophago-gastric reconstruction, 5 received primary sutures of the esophagus, 1 received reconstructive surgery with a pectoral muscle flap, and 1 underwent sternectomy plus intrathoracic omental transposition. Four patients died within 30 days of surgery (15.4%). The mortality rate in our practice is similar to that described in the literature. The results argue for early, aggressive treatment.

Thoracic complications of esophageal disorders.

Abnormalities of the esophagus are common, and complications associated with these disorders and diseases can involve the mediastinum, tracheobronchial tree, and lungs. The most common complications include mediastinitis secondary to esophageal perforation or postoperative anastomotic leak, or both; empyema due to fistula formation; and aspiration pneumonia. The authors reviewed the radiologic appearances of those and other common thoracic complications associated with esophageal disorders to facilitate early detection, diagnosis, and management. Computed tomographic (CT) findings of acute mediastinitis secondary to esophageal perforation may include esophageal thickening, extraluminal gas, pleural effusion, single or multiple abscesses, and extraluminal contrast medium. The radiologic manifestations of pneumonia secondary to tracheoesophageal fistula are variable, depending on the spread and severity of the aspiration. The most common radiographic pattern is that of bronchopneumonia with scattered air-space opacities. CT has been regarded as the imaging modality of choice for the evaluation of suspected esophagopleural fistula, because the site of communication between the pleural space and the esophagus can often be seen. An awareness of the radiologic manifestations of these complications is thus required to facilitate early diagnosis.

Detection of acute postoperative mediastinitis in mice using (99m)Tc-liposomes.

To evaluate the usefulness of size-modified (99m)Tc-labeled liposomes for the detection of acute postoperative mediastinitis in a mouse model. Fourteen mice underwent low-neck collar incision and had sterile abscesses induced in mediastinum with turpentine. Ten of these animals were injected intravenously with anionic liposomes of 516 +/- 20 nm containing poly(ethylene)glycol labeled with (99m)Tc; the remaining four mice were injected with (67)Ga citrate and used as positive controls. In addition, eight mice either underwent the same surgical procedure but without turpentine (n = 4) or were not operated (n = 4). These were used as negative controls. Therefore, scintigraphy using (99m)Tc-liposomes was performed in eighteen and (67)Ga citrate in four mice. Target area of interest was outlined, and target to background count density ratio and percentage-injected dose were measured. Significant accumulation of radiolabeled liposomes was observed at sites of inflammation within 1 hour in abscess-bearing animals. This correlated well with the findings of the lower quality (contrast) of (67)Ga images at 24 and 48 hours. The radiopharmaceutical did not significantly accumulate in the mediastinum of negative control animals. (99m)Tc-liposomes (size modified) may prove useful nonspecific agent for the early diagnosis of postoperative mediastinitis.

Revascularização do miocárdio em pacientes após a oitava década de vida

OBJETIVO: Avaliar a morbi-mortalidade hospitalar e a qualidade de vida de pacientes, acima de 70 anos de vida, submetidos à operação de revascularização do miocárdio (CRM). CASUÍSTICA E MÉTODOS: No período de julho de 1992 a fevereiro de 2000, foram realizadas 507 CRM, no Serviço de Cirurgia Cardiovascular do Instituto de Moléstias Cardiovasculares de Cascavel. Em 70 destes casos os pacientes tinham idade igual ou superior a 70 anos. Neste grupo predominou o sexo masculino, em 57% dos casos, e a idade média foi de 72,9 anos (70-85 anos). Vinte e seis pacientes apresentavam hipertensão arterial sistêmica, 25 doença pulmonar obstrutiva crônica importante, 17 diabete melito e 8 insuficiência renal crônica, no pré-operatório. Trinta e sete pacientes apresentavam infarto agudo do miocárdio (IAM) pré-operatório, sete haviam sido submetidos à angioplastia transluminal percutânea, sete apresentavam lesão de tronco de artéria coronária esquerda e um havia sido submetido à CRM anteriormente. Foram realizados 2,8 enxertos/ paciente, sendo usados condutos arteriais em 53% dos casos. Foi realizada endarterectomia em sete artérias, aneurismectomia de ventrículo esquerdo em sete pacientes e ventriculectomia parcial esquerda em um. A operação foi realizada em caráter de emergência em nove casos. Houve necessidade de contrapulsação aórtica em quatro pacientes. RESULTADOS: O tempo médio de permanência na UTI e no hospital foi de 4 (1-24) e 12,2 (3-34) dias, respectivamente. A mortalidade hospitalar geral foi de 7,1%. Quando analisada por subgrupos, a mortalidade dos pacientes de 70 a 74 anos (57 casos) foi de 5,3%, e a dos últimos 35 casos de 2,8%. No pós-operatório imediato, as complicações mais freqüentes foram: insuficiência respiratória (10), arritmia atrial (7), alteração de conduta (6), infecção pulmonar (6), embolia pulmonar (5), síndrome de baixo débito (4), IAM (3), AVC (3), insuficiência renal aguda (4) e mediastinite (1). No seguimento tardio, quatro (6,1%) pacientes foram a óbito, dois deles por causas não cardíacas. CONCLUSÃO: Diante destes resultados, os autores acreditam que a CRM pode ser realizada em indivíduos com idade superior a 70 anos, com mortalidade semelhante ao grupo total de pacientes submetidos à operação de revascularização do miocárdio. Entretanto, considerando-se as altas taxas de morbidade, há necessidade de indicação criteriosa e de preparo rigoroso para diminuir as complicações pós-operatórias.

Traitement des médiastinites post-sternotomie

Mediastinitis occurs with an incidence of 1–2% in patients undergoing median sternotomy. Treatment requires prompt medical and surgical intervention. Pus evacuation and debridement of infected necrotic tissues are essential steps. The surgeon can either let the thorax open or use a closed technique. Open method requires daily dressings. Healing is obtained by granulation tissue formation but needs a long period of time. Thus, secondary closure is performed in the majority of cases. More often, mediastinal closure is performed using either continuous irrigation or vacuum drainage with Redon catheters or transposition of muscle or omental flaps. In our current practice, closed drainage using Redon catheters is the therapy of choice of acute mediastinitis because it is simple and efficient. It is only in case of closed drainage failure or in patients with extensive destruction and loss of tissue that transposition of muscle or omental flaps is used. Medical treatment is based on bactericidal systemic antibiotic therapy. Combine and prolonged antibiotic therapy is recommended, using drugs diffusing well in bone. Staphylococci are responsible for 70% of infections. Thus, antibiotics with antistaphylococcal spectrum should be considered in the absence of positive cultures. Shock, multiorgan failure or local complications can justify a prolonged ICU stay. Prognosis has improved over the last two decades but overall mortality is still approximately 20%. Several factors were found to be associated with bad outcome. Preventive measures are essential to reduce the risk of this nosocomial infection.