Closed blunt chest trauma causing mediastinal abscess.

Posttraumatic bacterial mediastinal abscess resulting from closed blunt trauma without penetrating injury or tracheal or esophageal rupture is, to our knowledge, previously unreported. We report a case of a patient injured in a motor vehicle collision that resulted in closed blunt chest trauma and mediastinal abscess 14 days after injury. Initial chest roentgenogram revealed a widened mediastinum. Computed tomographic scan of the chest revealed comminuted fractures of the upper sternum, manubrium, and the 3rd and 4th left anteriolateral ribs and a retrosternal hematoma. Transesophageal echocardiography was negative. The patient was dismissed 2 days after injury and returned to the hospital 14 days after injury with a fluctuant, pulsatile, upper midline chest wall and anteriolateral chest wall staphylococcal abscesses. The abscesses were drained and the sternomanubrial wound debrided in stages. The mediastinal defect was reconstructed with a pectoralis major muscle flap. This most likely represents bacterial seeding of the mediastinal hematoma from a distant source.