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10 days post-operative total thyroidectomy for multinodular goiter with fever and discharge from the wound.
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Status post total thyroidectomy showing postoperative changes in the form of diffuse subcutaneous thickening and two surgical drains are seen within the operative bed in anterior lower neck regions.
Endotracheal and NG tubes are seen in situ.
Unremarkable the rest of supra and infrahyoid neck soft tissue spaces.
Diffuse smudged mediastinal fat planes and areas of fluid density disseminated in the mediastinal compartments with faint marginal enhancement are seen, encasing the SVC which showed filling defect within possible thrombosis associated with an enlarged necrotic subcarinal lymph node.
Bilateral subsegmental posterior consolidation and multiple patchy areas of ground-glass density scattered in both lungs suggestive of inflammatory changes.
Bilateral mild pleural effusions are seen.
Follow-up after 25 days
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Lungs are clear. Normal cardiothoracic ratio. No evidence of pleural effusion. Intact bony thoracic cage.
The postoperative status with above mentioned findings were suggestive of sequelae of an inflammatory process of mediastinitis for clinical correlation and the patient was treated medically.
The diagnostic confirmation by CT of mediastinitis is very important to prevent morbidity and mortality of late diagnosis. So it is essential to know the different characteristic signs of acute mediastinitis and its causes.
The three most common causes of acute mediastinitis are:
- post-surgical: most common cause of mediastinitis, mainly after cardiac curgery, with an incidence of 0.4-5%
- esophageal perforation
- descending necrotizing mediastinitis
- 1. Akman C, Kantarci F, Cetinkaya S. Imaging in mediastinitis: a systematic review based on aetiology. Clinical radiology. 59 (7): 573-85. doi:10.1016/j.crad.2003.12.001 - Pubmed
- 2. http://posterng.netkey.at/esr/viewing/index.php?module=viewing_poster&task=viewsection&pi=137829&ti=484886&searchkey=#poster2
- 3. McNeeley MF, Chung JH, Bhalla S, Godwin JD. Imaging of granulomatous fibrosing mediastinitis. AJR. American journal of roentgenology. 199 (2): 319-27. doi:10.2214/AJR.11.7319 - Pubmed
- 4. MK Dwivedi, RK Pal, R Gupta, SJ Rizvi, RP Singh, PB Borkar. CT findings of descending necrotizing mediastinitis. Indian Journal of Radiology and Imaging. 11 (3): 131.
- 5. Macedo, Clarissa Aguiar de, Baena, Marcos Eduardo da Silva, Uezumi, Kiyomi Kato, Castro, Cláudio Campi de, Lucarelli, Cláudio Luiz, Cerri, Giovanni Guido. Acute mediastinitis: multidetector computed tomography findings following cardiac surgery. Radiologia Brasileira. 41 (4): 269. doi:10.1590/S0100-39842008000400014
- 6. Jolles H, Henry DA, Roberson JP, Cole TJ, Spratt JA. Mediastinitis following median sternotomy: CT findings. Radiology. 201 (2): 463-6. doi:10.1148/radiology.201.2.8888241 - Pubmed
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