Chest
Volume 70, Issue 2, August 1976, Pages 308-309
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Selected Reports
Mediastinal Lipomatosis in Simple Obesity

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A case of superior mediastinal widening due to unusual amounts of fat accumulation is reported in a patient with simple obesity, not associated with iatrogenic or primary Cushing's syndrome. The radiographic features included a smooth bilateral widening of the superior mediastinum, relative lucency, no definable mass in the lateral view, and no pressure effects on the trachea. Such mediastinal lipomatosis is a benign condition and may be related to general obesity. Although rare, it should be considered in the differential diagnosis of mediastinal masses, particularly in obese individuals.

Section snippets

CASE REPORT

A 36-year-old white man entered the hospital because of chest discomfort of three months’ duration. There had been some recent occasional chest pain radiating towards the left arm. There were no complaints of dysphagia or dyspnea. The patient, who had never received any systemic steroid therapy, began to gain weight during the preceding three years. His past history was noncontributory. Physical examination revealed a well-developed, well-nourished obese man in no acute distress. Physical

DISCUSSION

Koerner and Sun2 reported three cases of mediastinal lipomatosis following large doses of systemic corticosteroid therapy. Thereafter, several authors1, 3, 4, 5, 6 reported a number of similar cases. All reported cases had in common some evidence of clinical Cushing's syndrome (either primary or iatrogenic).

In simple obesity, excessive fat is generally stored at various body sites, notably in the subcutaneous tissue, omentum, mesentery, and perirenal tissue. Although more fatty tissue may be

References (6)

  • JE Price et al.

    Widening of the mediastinum resulting from fat accumulation

    Radiology

    (1970)
  • HJ Koerner et al.

    Mediastinal lipomatosis secondary to steroid therapy

    Am J Roentgenol

    (1966)
  • SF Bodman et al.

    Mediastinal widening in iatrogenic Cushing's syndrome

    Ann Intern Med

    (1967)
There are more references available in the full text version of this article.

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    Citation Excerpt :

    ML is suggested by widening of the mediastinum bilaterally with smooth and sharply defined contours and absence of a definable mass on lateral view.6 The fat shadow is often poorly defined, creating a “double contour” effect,1 and is not as dense as other superior mediastinal masses3,4,6; however, lucency may not be as obvious because of the underlying lucent pulmonary tissue.3 This may also be called the “double contour” effect.

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