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Background Fibrosing mediastinitis is a rare benign disease frequently complicated by pulmonary hypertension. A definitive diagnosis for fibrosing mediastinitis-associated pulmonary hypertension (FM-PH) and its etiologies necessitates mediastinal biopsy and subsequent pathological assessment. Endobronchial ultrasound (EBUS)-guided transbronchial mediastinal cryobiopsy is a recently developed technique that provides diagnostic advantages over standard needle biopsy, particularly in benign mediastinal disorders. Nevertheless, their safety and efficacy in diagnosing FM-PH remain elusive. Methods We retrospectively studied patients with mediastinal lesion and pulmonary vascular compression who underwent both transbronchial needle aspiration and mediastinal cryobiopsy with EBUS guidance. Diagnostic yields of FM-PH and its etiologies, along with procedure-related adverse events, were analyzed. Immunohistochemical study was conducted to identify immunological properties of FM-PH. Results Of the 529 patients with mediastinal lesions, 80 exhibited pulmonary vessel compression, including 10 who were ultimately diagnosed with FM-PH following mediastinal biopsy and right heart catheterization. Cryobiopsy showed a higher diagnostic yield for FM-PH compared to needle aspiration (100% versus 40%, p  = 0.011). Disease etiologies included pneumoconiosis in 5 cases, tuberculosis in 3, and idiopathic FM-PH in the remaining 2. Cryobiopsy appeared to be superior to needle biopsy for etiological diagnosis, although this difference was not statistically significant (80% versus 60%, p  = 0.628). Immunohistochemical analyses of cryosamples revealed mixed inflammatory infiltrates of B and T lymphocytes, as well as macrophages, surrounding or within FM-PH lesions. There was no significant bleeding or other complications. Conclusion Transbronchial mediastinal cryobiopsy might be a safe and effective diagnostic tool for FM-PH, offering valuable information for personalized treatment.

Background: Head and neck infections are commonly caused by affections with an odontogenic origin. Untreated or non-responsive to treatment odontogenic infections can cause severe consequences such as localized abscesses, deep neck infections (DNI), and mediastinitis, conditions where emergency procedures such as tracheostomy or cervicotomy could be needed. Methods: An epidemiological retrospective observational study was performed, and the objective of the investigation was to present a single-center 5-years retrospective analysis of all patients admitted to the emergency department of the hospital Policlinico Umberto I “Sapienza” with a diagnosis of odontogenic related head and neck infection, observing the epidemiological patterns, the management and the type of surgical procedure adopted to treat the affections. Results: Over a 5-year period, 376,940 patients entered the emergency room of Policlinico Umberto I, “Sapienza” University of Rome, for a total of 63,632 hospitalizations. A total of 6607 patients were registered with a diagnosis of odontogenic abscess (10.38%), 151 of the patients were hospitalized, 116 of them were surgically treated (76.8%), and 6 of them (3.9%) manifested critical conditions such as sepsis and mediastinitis. Conclusions: Even today, despite the improvement of dental health education, dental affections can certainly lead to acute conditions, necessitating immediate surgical intervention.

Abstract Introduction: Most paediatric upper respiratory infections are virally mediated and result in self-limiting reactive lymphadenopathy. In children younger than 5 years, retropharyngeal lymph nodes may give rise to deep neck space infections in this potential space. Retropharyngeal infections are rare after 5 years because lymph nodes undergo atrophy. Methods: We present a series of 6 cases of paediatric retropharyngeal abscesses (RPA) complicated by mediastinitis, managed at a tertiary hospital over a 4-year period. Results: All our cases presented with fever, difficulty feeding, and neck swelling. The age range was 11 weeks–11 months, and all tested negative for human immunodeficiency virus. The diagnosis and complications were confirmed on computed tomography (CT) scan. The CT scans consistently revealed RPA with varying degrees of deep neck space and mediastinal extension. All children were promptly taken to theatre for source control. Two were extubated successfully immediately after surgery, and the other 4 were extubated in the paediatric intensive care unit, with the longest duration of intubation being 3 days. Methicillin-sensitive Staphylococcus aureus (MSSA) was cultured in all 6 cases. Conclusion: Management of these cases may be challenging, and young children with RPA require close care and airway monitoring. CT or magnetic resonance imaging is essential to delineate the extent of infection. Surgical drainage should be performed when there is a large abscess, a complication occurs, or an inadequate response in 24–48 h to medical management.

Purpose The primary aim of this retrospective study was to analyze the progression of descending necrotizing mediastinitis (DNM), evaluate the impact of comorbidities on complications and mortality and to observe long-term consequences of DNM on dysphagia and measurements quality of life. DNM is a serious infectious disease that requires multimodal treatment. Current literature varies in conclusions of risk factors, management and outcome of DNM. In addition, little is known about persisting effects on quality of life. Methods Retrospective data analysis of 88 patients with DNM representing the largest single-center study. Recording data of patients and diseases as well as clinical progression from 1997 to 2018. Two questionnaires were sent to the participants to measure quality of life and to detect dysphagia. Results 88 patients were included. The most frequently found pathogen were Streptococcus spp. (52%). 75% of the patients underwent multiple surgeries, mean count of surgical procedures was 4.3 times. 84% received intensive care treatment. Median length of stay on the intensive care unit was 7 days. 51% had pre-existing comorbidities associated with reduced tissue oxygenation (e.g., diabetes). The most common complication was pleural effusion (45%). During the observation period, the mortality rate was 9%. 12 questionnaires could be evaluated. 67% of the participants were affected by dysphagia at the time of the survey. Conclusions Descending necrotizing mediastinitis (DNM) is a severe disease requiring an immediate initiation of multimodal treatment. Although quality of life usually isn´t impaired permanently, dysphagia may often persist in patients after DNM.

Objective A retrospective analysis of patients with descending necrotizing mediastinum (DNM) admitted to the emergency department was performed to improve emergency physicians’ knowledge of DNM, so as to achieve early judgment and timely resuscitation of DNM and to avoid delays in the diagnosis and treatment of patients. We explored the use of the NEWS2 to assess the condition of DNM patients, hoping to enable timely treatment and prevent adverse events. Methods A retrospective review was conducted on the clinical data of 30 patients who were admitted to our hospital and ultimately diagnosed with DNM between 2014 and 2023. NEWS2 were calculated based on the clinical data of DNM patients at the time of emergency admission. Patients were then grouped according to their scores to explore the relationship between the score and adverse events during hospitalization as well as prognosis. Results A total of 30 DNM patients were included, 22 of whom were male (73.3%). The median age was 53 years (range: 47.75 to 62.50 years). Seven patients were diagnosed upon emergency admission, while 23 had an undetermined diagnosis, yielding an emergency department misdiagnosis rate of 76.7%. According to the NEWS2, 19 patients were classified into the low-risk group, 6 into the medium-risk group, and 5 into the high-risk group. During hospitalization, 14 patients (46.7%) experienced critical events, including 2 cases of cardiac arrest. Thirteen patients (43.3%) developed secondary sepsis, with incidence rates of 31.6%, 66.7%, and 60.0% in the low-risk, medium-risk, and high-risk groups, respectively. Eleven patients died: 5 in the low-risk group (26.3%), 2 in the medium-risk group (33.3%), and 4 in the high-risk group (80.0%).

Background Ureaplasma urealyticum , a commensal organism, is potentially pathogenic. In solid organ transplant recipients, non-genitourinary U. urealyticum infection is associated with an increased risk of graft failure or death. Results We reported a case of mediastinitis caused by U. urealyticum in a heart transplant recipient and reviewed 13 other cases previously described. Among the 14 patients, 3 were female and 11 were male, with a median age of 61 years. The median time to symptom onset was 9 days after surgery. Among the 10 documented cases with reported symptoms, altered mental status and hyperammonemia syndrome occurred in 9 cases, whereas our patient manifested persistent fever. Both culture and molecular diagnostics were employed in the reviewed cases, with molecular methods predominating. U. urealyticum was difficult to cover with initial empirical antibiotic therapy; the patient in this study improved after omadacycline antimicrobial therapy and was successfully discharged following subsequent management. Regarding clinical outcomes, four patients died or withdrew from treatment, while targeted therapy duration among surviving patients ranged from 9 days to 4 weeks. Conclusions There is a possibility of severe U. urealyticum infection in patients with immunodeficiency after organ transplantation. Monitoring ammonia levels, utilizing rapid diagnostics, and initiating prompt treatment are all crucial to improving prognosis and reducing severe nerve damage, organ dysfunction, and mortality. Clinical trial number Not applicable.

Purpose Culture of extracted drains or epicardial pacing wires is an easy and noninvasive method for detecting mediastinitis after open-heart surgery, although studies on its sensitivity and specificity are limited. We, therefore, investigated the usefulness of this approach for diagnosing mediastinitis. Methods We retrospectively studied the culture results of drains and epicardial pacing wires extracted from 3308 patients. Prediction models of mediastinitis with and without culture results added to clinical risk factors identified by a logistic regression analysis were compared. Results The incidence of mediastinitis requiring surgery was 1.89% ( n  = 64). Staphylococcus was the causative bacterium in 64.0% of cases. The sensitivity, specificity, and positive and negative predictive values of positive culture results were 50.8%, 91.8%, 10.7%, and 99.0%, respectively. Methicillin-resistant Staphylococcus aureus had the highest positive predictive value (61.5%). A multivariate analysis identified preoperative hemodialysis (OR 5.40 [2.54−11.5], p  < 0.01), long operative duration ( p  < 0.01), postoperative hemodialysis (OR 2.25 [1.01−4.98], p  < 0.05), and positive culture result (OR 10.2 [5.88−17.7], p  < 0.01) as independent risk factors. The addition of culture results to pre- and postoperative hemodialysis and a lengthy operative time improved the prediction of mediastinitis. Conclusions A culture survey using extracted drains and epicardial pacing wires may provide useful information for diagnosing mediastinitis.

Background Fibrosing mediastinitis (FM) is a rare but serious condition characterized by excessive fibrous tissue proliferation in the mediastinum, often leading to compression of vital structures. Although considered benign, in people, clinical manifestations of FM can range from asymptomatic incidental findings on imaging studies to severe respiratory compromise and hemodynamic instability. While documented in people, FM has not yet been reported in dogs. Case Presentation A 5‐year‐old male neutered Labrador Retriever presented with progressive respiratory distress, leading to pleural effusion and facial swelling. Thoracic radiographs revealed mediastinal mass‐like structures and pleural effusion. Computed tomography demonstrated a mediastinal mass‐like structure, enlarged tracheobronchial lymph nodes, multifocal narrowing of lobar bronchi and pulmonary veins and compression of the oesophagus and trachea. The dog was humanely euthanized due to poor response to empiric therapy and the owner's perception of suffering. A post‐mortem examination confirmed severe chronic mediastinal inflammation with fibrosis and vasculitis consistent with fibrosing mediastinitis. Conclusions This report presents a unique case of FM in a dog. This case report describes the first documented instance of fibrosing mediastinitis in a dog, characterized by chronic cough, progressive aphonia, pleural effusion and cranial vena caval syndrome. Advanced imaging revealed a soft tissue‐dense mediastinal mass, and histopathology confirmed dense fibrous tissue with chronic inflammation and vasculitis. This case highlights the clinical, imaging and pathologic parallels between veterinary and human presentations of fibrosing mediastinitis and emphasizes the importance of considering this disease in dogs with acute development of unexplained, non‐infectious, pyogranulomatous intrathoracic disease.

Pulmonary hypertension (PH) often leads to poor survival outcomes and encompasses diverse subtypes with distinct underlying causes. Specifically, PH resulting from fibrosing mediastinitis (FM‐PH) presents significant diagnostic challenges due to nonspecific symptoms and overlap of clinical characterization with other PH subtypes, leading to frequent misdiagnosis and delayed treatment. Moreover, the complex diagnostic procedures impose a significant burden on FM‐PH patients, many of whom already experience mobility difficulties. This study represents a single test‐based diagnosis of FM‐PH, using the plasma metabolites obtained through ferric particle‐enhanced laser desorption/ionization mass spectrometry analysis. Distinct metabolic alterations in FM‐PH are identified compared to healthy controls and other PH subtypes, achieving an area under the curve (AUC) of 0.987 for FM‐PH diagnosis and 0.728 for differentiating FM‐PH from other subtypes. By addressing existing gaps in diagnostic strategies, this research highlights the potential of metabolic analysis in elucidating the metabolic landscape of PH. Pulmonary hypertension caused by fibrosing mediastinitis has a five‐year survival rate of just 56%. Current diagnostic approaches are complex for patients with mobility limitations and can lead to misdiagnoses due to their nonspecific clinical features. This work presents a straightforward and precise strategy based on metabolic analysis—a single test with an accuracy of 93.6%—to complement existing diagnostic modalities.