This review article outlines the etiological factors of primary mediastinitis. As early as the 19th century, surgeons described two principal pathways of infection spread into the mediastinum: through esophageal perforation and via the fascial and cellular spaces of the neck. This concept forms the basis for classifying mediastinitis into primary and secondary types.Primary purulent mediastinitis is defined as a condition arising as a direct purulent complication of diseases or injuries affecting the mediastinal organs. In contrast, secondary purulent mediastinitis develops due to either direct extension or hematogenous dissemination of infection from an existing purulent focus located outside the mediastinum.From a clinical perspective, it is also reasonable to distinguish postoperative mediastinitis as a separate category.In conclusion, primary mediastinitis remains a clinically significant condition, and continued research and expertise in this area of surgery are still highly relevant.

primary mediastinitis, suppurative mediastinal infection, esophageal injury, computed tomography imaging, surgical infections, thoracic surgical practice

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