Acute mediastinitis is a rare but life threatening clinical entity. Before the development of cardiac surgery, perforation of the esophagus was the leading cause of mediastinitis, followed by suppurative infections of the oropharynx. Currently, mediastinitis following cardiac surgery is the most common form. The clinical features of mediastinitis differ according to the underlying cause of the disease. Since the morbidity and mortality rates of mediastinitis are high, appropriate antibacterial prophylaxis and prompt initiation of empirical antibacterial therapy together with surgical debridment in case of clinical suspicion of mediastinitis is of paramount importance.