CTICasesAcute Mediastinitis caused by Streptococcus pyogenes
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Imaging findings
Chest CT demonstrates diffuse, extensive infiltration of the mediastinal fat, mimicking the appearance of a confluent mediastinal tumor or lymphoma. Bilateral pleural effusions and a small focus of consolidative atelectasis in the right lung base are also present. A chest radiograph obtained only one day prior shows a completely normal mediastinal contour with no widening.
Key takeaways
Acute mediastinitis is a rapidly progressive and life-threatening bacterial infection that can mimic lymphoma on CT due to diffuse soft-tissue infiltration of the mediastinal compartments. Sepsis from Streptococcus pyogenes (group A streptococcus) can cause primary or hematogenous mediastinitis, occasionally occurring as a deadly secondary bacterial infection following H1N1 influenza. Comparing the CT to a very recent chest radiograph can be the vital clue to distinguishing hyperacute mediastinitis from a chronic neoplastic process like lymphoma.
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