Mediastinitis: Causes, Symptoms, and Treatment
Medically reviewed by Harsha Moole, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Mediastinitis?
The care team often includes a thoracic surgeon, who operates on the chest. It also may include an infectious disease doctor, who treats serious infections. Treatment often needs ongoing care in a hospital intensive care unit. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What is mediastinitis?
Mediastinitis is swelling and irritation of the chest area between the lungs. This area is called the mediastinum. It holds the heart, large blood vessels, windpipe, food tube, thymus gland, and lymph nodes. Mediastinitis usually results from an infection. It may start suddenly, which is called acute. Or it may build slowly and get worse, which is called chronic.
Doctors describe three main types. The postoperative type, which follows surgery, is the most common. The descending necrotizing type starts as an infection in the mouth, throat, or neck and spreads down into the chest. The fibrosing type is the least common. It is a slower, long-term process.
Symptoms
Symptoms of mediastinitis may include:
- Chest pain.
- Fever and chills.
- A general feeling of discomfort.
- Shortness of breath.
- Trouble swallowing.
After recent surgery, signs can include chest wall tenderness, wound drainage, and a sensation of air trapped under the skin. The fibrosing type often grows slowly. Many people have no symptoms at first. Later symptoms can include cough, shortness of breath, fever, weight loss, or coughing up blood.
Causes and who gets it
It most often occurs in people who recently had chest surgery or an upper GI endoscopy, a scope test of the food tube. A tear in the esophagus, the food tube, can also cause it. Causes of the tear include a procedure such as an endoscopy, forceful or constant vomiting, and trauma.
Other causes include:
- Fungal infections such as histoplasmosis.
- Bacterial infections such as anthrax or tuberculosis.
- Radiation to the chest.
- Sarcoidosis, a disease with inflammation of the lymph nodes, lungs, and other tissues.
- Cancer, such as lung cancer or lymphoma.
- A severe dental infection that spreads into the chest.
- Infections in the lungs that spread to the mediastinum.
Risk factors include:
- Chronic obstructive pulmonary disease (COPD), a long-term lung disease.
- Diabetes.
- Kidney failure.
- Obesity.
- A weakened immune system.
- Disease of the esophagus or other problems in the upper digestive tract.
- Smoking.
How doctors diagnose it
A provider does a physical exam. They ask about your symptoms and medical history. Tests may include a chest CT scan or MRI scan, a chest x-ray, or an ultrasound. A chest x-ray often lacks detail. CT and MRI are better tools. Your provider may put a needle into the inflamed area to take a sample. The sample is tested to find the type of infection. Blood tests can show signs of infection, and blood cultures check for bacteria in the blood.
Treatment
You may receive antibiotics if you have an infection. Doctors first use broad-spectrum antibiotics, which work against many kinds of bacteria. They later adjust them based on culture results. You may need surgery to drain the area of inflammation. After surgery, doctors repeat CT scans and closely watch lab results and your condition.
The fibrosing type has no standard treatment plan. Proof that medicines help is limited. Surgery such as stent placement may be considered for people with symptoms.
When to see a doctor
Contact your provider if you had chest surgery or trauma and then get chills or fever. Also call if the wound drains fluid. If you have a lung infection, cancer, or sarcoidosis, contact your provider right away if you get chills, fever, or drainage from a wound.
This illness after chest surgery or injury is very serious. There is a risk of dying if it is not found and treated quickly.
Call 911 or go to the emergency room if you have chest pain lasting two minutes or more, trouble breathing, fainting, coughing up blood, or a sudden change in mental state, such as confusion.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. They can help coordinate follow-up care with the hospital team and specialists.
Common questions
Is mediastinitis serious?
Yes, it is serious. After chest surgery or injury, there is a risk of dying from it if it is not identified quickly and treated. How well a person does depends on the cause and severity.
What causes mediastinitis?
Mediastinitis usually results from an infection. It most often occurs in people who recently had an upper GI endoscopy or chest surgery. A tear in the esophagus can also cause it.
How is mediastinitis treated?
Treatment can include antibiotics, medicines that fight infection, and sometimes surgery. Surgery drains the inflamed area when the blood vessels, windpipe, or esophagus are affected.
Can mediastinitis be prevented?
It may be prevented in some cases. After chest surgery, surgical wounds should be kept clean and dry. Treating tuberculosis, sarcoidosis, dental infections, or related conditions may also prevent this complication.
Can mediastinitis cause other problems?
Yes, the infection can spread to the bloodstream, blood vessels, bones, heart, or lungs. It can also cause scarring. Scarring can be severe and can interfere with heart or lung function.
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Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
