Herrera-Jurado EF, Gómez-Camargo C, Criales-Vera SA

Language: Spanish
References: 23
Page: 268-275
PDF size: 734.67 Kb.

ABSTRACT

Objetive: describe the most common findings obtained by computerized tomography in patients with diagnosis of acute post-operative mediastinitis.
Material and Methods: a descriptive, observational, retrospective study of 94 patients who underwent heart surgery at Instituto Nacional de Cardiología Dr. Ignacio Chávez in Mexico City and had clinical suspicion of acute post-operative mediastinitis, all in the period between January 2012 and December 2014. The selection of cases was made based on the referral diagnosis reporting clinical suspicion of post-operative mediastinitis and records kept by the institute’s committee on hospital infections with bacteriological diagnosis of mediastinitis. Cross referencing was applied with demographic variables, tomography findings, and reports of causal microbial agents. Statistical analysis was conducted with SPSS v.24 statistical software for distribution of frequencies and percentage distribution.
Results: 68 patients with clinical suspicion of mediastinitis underwent tomographies, 30 of them were reported as probable mediastinitis, which was confirmed by microbiological culture; 28 of the cases were not compatible with mediastinitis in the tomographies, while 4 and 6 patients were false positives and negatives, respectively. This allows us to establish that in our study tomography had 83% sensitivity and 87% specificity, 88% positive predictive value, and 82% negative predictive value. In 26 of the cases reported as mediastinitis, the committee on infections did not use tomography as a diagnostic method. Valve replacement surgery was the most frequent procedure (42.6%), followed by coronary revascularization surgery (33.8%). The most common tomography findings included; alteration in attenuation of mediastinal fat (83%), pleural effusion (80%), mediastinal collection (63.3%), pericardial effusion (53.3%), pneumomediastinum (40%), sternal wound dehiscence (33.3%), collection in presternal soft tissue (33.3%), and adenomegaly (23.3%).
Conclusions: today, acute mediastinitis is the leading complication following cardiothoracic surgery, especially valve replacement and coronary revascularization. Computerized tomography is a non-invasive method particularly useful in differentiating superficial infectious processes involving the mediastinum; however, in 26.7% of the study cases, the diagnosis was based on clinical findings and microbiological studies, with Staphylococcus epidermidis the causal agent most frequently involved in mediastinal infection, similar to results from other series. The rate of mortality remains significant in this group of patients; in our series, it was estimated at 33.8%.

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