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Mediastinitis

Symptoms

Current of disease the heavy. Mediastinitis as complication of variety of diseases is shown by condition deterioration at already available heavy pathology. At occurrence mediastinitis against odontogenic phlegmons of a neck the patient has a pain behind a breast, high temperature, a fever, a tachycardia. At neck survey sharply painful inflammatory infiltrate reaching a clavicle is marked. If opening of a phlegmon of a neck from wounds departs considerable separated, sometimes with an unpleasant putrefactive smell earlier was spent. At effleurage on a breast the pain amplifies. In blood - high leukocytosis with formula shift to the left. Radiological research finds out shade expansion mediastinum. At tool punching of a gullet there is a damage of a pear-shaped sine is more often. For the account insufflation air at the moment of research the infection quickly extends on mediastinum. Intoxication signs appear very much early and promptly progress. Quite often right after research are marked hypodermic crepitus on a neck, a pain behind a breast with irradiation in a neck and interscapular space. In some hours the temperature considerably raises, there is a fever, profuse a sweat, a tachycardia, there can be clinical displays of septic shock. In blood - high leukocytosis with formula shift to the left. Shade expansion mediastinum, a cellulose emphysema mediastinum, necks. At contrasting a gullet (only water-soluble contrast substances) can be revealed a place and the size of punching, however at micropunching leaking contrast for gullet limits to reveal difficultly.

Treatment

Make drainage celluloses mediastinum, more often cervical access. A dvuhprosvetnyj drainage deduce through a separate cut, wound take in tightly. After operation spend active aspirate separated with cavity and drainage washing. At mediastinitises because of gullet punching at endoscopy to take in defect usually it is not obviously possible, effectively active drainage mediastinum. A food of the patient is carried out through the soft fallen down probe entered into a stomach. Spend also massive detoxication therapy, enter antibiotics of a wide spectrum of action. At considerable damages on the size of chest department of the gullet, accompanied by damage of a pleural leaf, small terms (less than days) after punching make transthoracic suture defect, drainage mediastinum and a pleural cavity. After operation to the patient spend probe a food. Complications: Sepsis, empyema pleurae, in the remote terms probably development fibrosis mediastinum. The forecast is always very serious. It depends on character of the basic disease, entrance gate of an infection, an activator kind.

Chronic mediastinitis often grows out of a tubercular infection (bronchoadenitis), the fungoid defeats, transferred sharp purulent mediastinitis. Clinical displays are caused developing fibrosis celluloses mediastinum and progressing squeezed the top hollow vein, a gullet, pulmonary veins. Patients complain of a pain, rise in temperature, a short wind at physical activity, voice change (stifled returnable nerves). Clinical displays correspond to expansion degree mediastinum at radiological research of a thorax. Signs stifled the top hollow vein are marked even in the absence of radiological changes. The diagnosis specify at angiographic and tomographic research.

Treatment operative. During operation specify morphological and etiological the diagnosis. The forecast is serious.

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