Keywords:
Mediastinum, Thorax, CT, Diagnostic procedure, Contrast agent-intravenous, Acute, Abscess, Infection
Authors:
M. Mueller1, B. Foldyna2, C. Luecke1, M. Haensig1, S. Nitzsche1, T. Klemm1, W. Mohr1, M. Gutberlet1, L. Lehmkuhl1; 1Leipzig/DE, 2Boston/US
Results
Qualitative analysis: All CT-datasets were evaluated qualitatively.
The frequencies of evaluated parameters are found in table 1.
Frequencies in mediastinitis-positive and -negative patients (according to clinical standard of reference) were compared statistically.
The comparison showed that free gas bubbles (OR=3.8,
95%CI [1.4,
10.1]) and pleural effusions (OR=4.9,
95%CI [1.8,
13.3]) occurred significantly more often in infected patients.
The remaining qualitative parameters did not show a significant difference.
Quantitative analysis: 64 CT-datasets were evaluated quantitatively.
Results are found in table 1.
Results were compared statistically between mediastinitis-positive and -negative patients (according to clinical standard of reference).
Only brachiocephalical lymph node size (p=0.022) differed significantly between the two groups.
Furthermore,
ROC-Analysis was employed to establish thresholds for parameters exhibiting an AuC>0.6.
The thresholds were then used to determine incidences.
A total mediastinal volume ≥250 ml (p=0.013,
OR=5.4 [1.3,
21.7]),
a mediastinal fluid volume ≥96 ml (p=0.041,
OR=4.4 [1.1,
17.2]) or a mediastinal air volume air >0.02 ml (p=0.020,
OR=5.2,
95%CI [1.3,
20.4]) were revealed to occur significantly more often in infected patients.
Clinical data: Median leukocytes value was 10.50 (quartiles: 8.06 – 14.00) Gpt/l and CRP value was 114.4 (60.0 – 200.1) mg/l.
With a p-value of 0.001 in Mann-Whitney-U,
CRP-value showed a significantly different distribution between infected and non-infected patients.
Reliable revision surgery reports were available for 122 (91.0%) patients and 105 (86.1%) described an infection at any place.
Reliable statements about mediastinal infection were available for 98 (73.1%) patients,
with 69 (70.4%) described as positive,
and about osteomyelitis for 108 (80.6%) patients,
with 43 (39.8%) described as positive,
respectively.
Microbiological data: Valid microbiological findings were available for 51 (38.1%) patients.At least one pathogen type was found in 39 (76.5%) of them.
Most common types were Staphylococcus epidermidis (n=16,
31.4%),
Staphylococcus aureus (n=8,
15.7%) and Serratia marcescens (n=7,
9.8%).
Clinical standard of reference: For 106 (79.1%) patients a reliable report on retrosternal infection status and/or a valid microbiological diagnosis was available,
thereby fulfilling the clinical standard of reference criteria.
Among these patients,
84 (79.2%) presented acute infectious mediastinitis.