Anterior mediastinal extension of primary chest wall infections: role of spiral CT in detection and management.

Abstract

Unlabelled: The purpose of this review was to define the role of spiral CT in the diagnosis and clinical management of patients with mediastinal infections resulting from extension of anterior chest wall infections. The review focuses on determining the frequency of mediastinal extension of chest wall infections as well as to define the patterns spread.

Subjects and methods: CT scans of 22 consecutive patients collected over a 2-year period with anterior chest wall infections were evaluated both prospectively and retrospectively. Clinical, pathologic, and CT characteristics of the infections were evaluated. The extension of the infection into the mediastinum as well as the role of CT in diagnosis and management of these patients was examined.

Results: Of the 22 patients, 10/22 (45.4%) showed CT evidence of mediastinal infection. Extension of chest wall infection occurred in patients with both soft tissue and sternoclavicular joint processes. The assessment of mediastinal involvement was best seen at the level of the great vessels origin from the aortic arch. CT findings in the mediastinum included fat hyperdensity and stranding, fluid collections (abscess), and mass effect on the great vessels. Sensitivity and specificity of CT for determination of mediastinal infection were both 100%. In 5 of 10 cases with evidence of mediastinal extension, the clinical situation required surgical drainage. In the other five cases the patients were managed with antibiotic therapy alone.

Conclusions: Mediastinal involvement of chest wall infections is a common occurrence. Conservative and/or surgical management must be tailored to the patient. Factors to consider in management decisions include the clinical status, CT findings, and patient compliance. Rapid CT evaluation may permit timely surgical intervention, limiting complications in some patients.