Carrol C L, Jeffrey R B, Federle M P, Vernacchia F S
J Comput Assist Tomogr. 1987 May-Jun;11(3):449-54. doi: 10.1097/00004728-198705000-00015.
Of 104 patients evaluated for thoracic sepsis by CT, 22 patients had both CT and clinical evidence of mediastinal infections. The CT findings in these patients were reviewed and compared with a control group of seven postoperative patients following uncomplicated median sternotomy. Based on CT appearance, patients were classified into one of three groups: (a) diffuse soft tissue infiltration with or without gas (i.e., mediastinitis) (10 patients); (b) focal mediastinal abscess (four patients); (c) mediastinal infection associated with empyema or subphrenic abscess (eight patients). Computed tomography proved reliable in distinguishing diffuse mediastinitis from a localized drainable abscess. However, in the absence of mediastinal gas, CT could not differentiate mediastinitis from benign postoperative changes. Computed tomography was helpful in identifying associated empyemas and a variety of other secondary complications. In five of six patients with mediastinal abscess, CT demonstrated communication or contiguity with four empyemas and one subphrenic abscess. Closed chest tube drainage of the empyemas and percutaneous drainage of the subphrenic abscess combined with antibiotic therapy were successful in treating the mediastinal abscess in these five patients. Although overall mortality for mediastinal infection in this series was 27%, there was a 50% mortality for patients with diffuse mediastinitis.
在104例接受胸部CT评估是否存在胸部脓毒症的患者中，有22例患者同时具备CT及纵隔感染的临床证据。对这些患者的CT检查结果进行了回顾，并与7例接受单纯正中开胸术后无并发症的患者组成的对照组进行了比较。根据CT表现，将患者分为三组之一：（a）伴有或不伴有气体的弥漫性软组织浸润（即纵隔炎）（10例患者）；（b）局灶性纵隔脓肿（4例患者）；（c）与脓胸或膈下脓肿相关的纵隔感染（8例患者）。计算机断层扫描在区分弥漫性纵隔炎与局限性可引流脓肿方面被证明是可靠的。然而，在没有纵隔气体的情况下，CT无法区分纵隔炎与良性术后改变。计算机断层扫描有助于识别相关的脓胸和各种其他继发性并发症。在6例纵隔脓肿患者中的5例中，CT显示与4例脓胸和1例膈下脓肿存在相通或相邻关系。对脓胸进行闭式胸腔引流以及对膈下脓肿进行经皮引流并联合抗生素治疗，成功治愈了这5例患者的纵隔脓肿。尽管该系列中纵隔感染的总体死亡率为27%，但弥漫性纵隔炎患者的死亡率为50%。
