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01-06-2019 | Computed Tomography | Chest

Computed tomography improves the differentiation of infectious mediastinitis from normal postoperative changes after sternotomy in cardiac surgery

Authors: Borek Foldyna, Martin Mueller, Christian D. Etz, Christian Luecke, Josephina Haunschild, Ines Hoffmann, Matthias Gutberlet, Lukas Lehmkuhl

Published in: European Radiology | Issue 6/2019

Abstract

Objectives

To identify CT parameters independently associated with infectious mediastinitis after cardiac surgery and to improve the discrimination of patients with acute infection from those with normal postoperative changes.

Methods

In this single-center, retrospective, observational cohort study, we evaluated thoracic CT scans of poststernotomy cardiac surgery patients. Inclusion criteria were clinically suspected mediastinitis, unclear CT signs (e.g., retrosternal mass), and subsequent deep revision surgery. Revision surgery and microbiological samples determined the mediastinitis status. Overall, 22 qualitative and quantitative CT imaging parameters were assessed and associated with infectious mediastinitis in univariate and multivariate regression models. Discriminative capacity and incremental value of the CT features to available clinical parameters were determined by AUC and likelihood-ratio tests, respectively.

Results

Overall 105 patients (82% men; 67.0 ± 10.3 years) underwent CT and deep revision surgery. Mediastinitis was confirmed in 83/105 (79%) patients. Among available clinical parameters, only C-reactive protein (CRP) was independently associated with infectious mediastinitis (multivariate odds ratio (OR) (per standard deviation) = 2.3; p < 0.001). In the CT, the presence of free gas, pleural effusions, and brachiocephalic lymph node size were independently associated with mediastinitis (multivariate ORs = 1.3–6.3; p < 0.001–0.039). Addition of these CT parameters to CRP increased the model fit significantly (X² = 17.9; p < 0.001; AUC, 0.83 vs. 0.73).

Conclusion

The presence of free gas, pleural effusions, and brachiocephalic lymph node size in CT is independently associated with infectious mediastinitis in poststernotomy patients with retrosternal mass. These imaging features may help to differentiate mediastinitis from normal postoperative changes beyond traditional clinical parameters such as CRP.

Key Points

• Presence of free gas, pleural effusions, and brachiocephalic lymph node size on CT are associated independently with infectious mediastinitis.

• Combination of these CT parameters increases the discriminatory capacity of clinical parameters such as CRP.

Available only for authorised users

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Title: Computed tomography improves the differentiation of infectious mediastinitis from normal postoperative changes after sternotomy in cardiac surgery
Authors: Borek Foldyna
Martin Mueller
Christian D. Etz
Christian Luecke
Josephina Haunschild
Ines Hoffmann
Matthias Gutberlet
Lukas Lehmkuhl
Publication date: 01-06-2019
Publisher: Springer Berlin Heidelberg
Keywords: Computed Tomography
Heart Surgery
Computed Tomography
Pleural Effusion
Heart Surgery
Sternotomy
Mediastinitis
Mediastinitis
Published in: European Radiology / Issue 6/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-018-5946-5

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Computed tomography improves the differentiation of infectious mediastinitis from normal postoperative changes after sternotomy in cardiac surgery

Abstract

Objectives

Methods

Results

Conclusion

Key Points

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusion

Key Points

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