CLOSED BLUNT CHEST TRAUMA CAUSING MEDIASTINAL ABSCESS

Posttraumatic bacterial mediastinal abscess resulting from closed blun t trauma without penetrating injury or tracheal or esophageal rupture is, to our knowledge, previously unreported, We report a case of a pat ient injured in a motor vehicle collision that resulted in closed blun t chest trauma and mediastinal abscess 14 days after injury, Initial c hest roentgenogram revealed a widened mediastinum. Computed tomographi c scan of the chest revealed comminuted fractures of the upper sternum , manubrium, and the 3rd and 4th left anteriolateral ribs and a retros ternal hematoma, Transesophageal echocardiography was negative. The pa tient was dismissed 2 days after injury and returned to the hospital 1 4 days after injury with a fluctuant, pulsatile, upper midline chest w all and anteriolateral chest wall staphylococcal abscesses, The absces ses were drained and the sternomanubrial mound debrided in stages. The mediastinal defect was reconstructed with a pectoralis major muscle f lap, This most likely represents bacterial seeding of the mediastinal hematoma from a distant source.