Injuries of the Mediastinum and Esophagus

Retained foreign bodies in the mediastinum, such as bullets and shell fragments, may produce erosion into the great vessels and myocardium. Irritation may produce recurrent pericardial and pleural effusion. Being contaminated upon entrance, a foreign body may be the site of recurrent infection and may give rise to embolic phenomena, either septic or of the missile itself. They should be surgically removed by elective thoracotomy. In hemomediastinum, there is a widening of the mediastinal shadow in the chest film, with straight, smooth margins. Occasionally, fracture of the sternum may give a hematoma on the posterior surface of that bone, which is seen on the lateral chest roentgenogram. In almost all cases the bleeding is from small veins, and conservative treatment is indicated—bed rest and sedation. In the majority of cases, the bleeding will cease rapidly and the hematoma will be reabsorbed in two or three weeks. Tracheotomy should be performed