CTICasesMediastinitis from Infected Breast Tissue Expander
Imaging findings
A 19-year-old woman who had undergone bilateral mastectomy with tissue expander placement for painful breast fibrosis presented with signs of right-sided infection the day after removal of the right tissue expander (left expander still in place). Radiograph showed edema, atelectasis, a pleural effusion, and unexpected widening of the mediastinum; CT showed smudgy subcutaneous fat stranding reflecting inflammation, a small pericardial effusion, and diffuse tissue stranding throughout the upper mediastinal fat without discrete abscess, consistent with mediastinal cellulitis (mediastinitis) accounting for the associated atelectasis, pleural effusion, and lung edema from lymphatic obstruction; skin cultures grew methicillin-sensitive Staphylococcus aureus, and she improved with intravenous then oral antibiotics.
Key takeaways
Mediastinal widening in a young, non-obese patient after breast implant/expander removal should not be assumed to be vascular injury or malignancy without first considering contiguous spread of a soft tissue infection into the mediastinum; diffuse mediastinal fat stranding without a discrete abscess can still represent mediastinal cellulitis and can secondarily cause pleural effusion and pulmonary edema through lymphatic obstruction.
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