Gigantic primary lipoma of the diaphragm presenting with respiratory failure

Abstract

Primary diaphragmatic lipomas are rare. A 66-year-old female case is reported, with the unusual presentation of progressive dyspnoea leading to respiratory failure, mainly because of a large fatty mass occupying the base of the left hemithorax. The completely resected mass (16 x 14.5 x 5.5 cm) was a primary diaphragmatic lipoma. The literature is discussed. We recommend surgical exploration since the possibility of liposarcoma cannot be excluded.

Tumors of the Diaphragm

“…1). 37,39 Sometimes, a primary lipoma of the diaphragm is mistaken for Bochdalek hernia. A potentially distinguishing CT finding is that the integrity of the diaphragm is complete with lipoma while Bochdalek hernias present with a V-shaped discontinuation of the diaphragm.…”

“…A potentially distinguishing CT finding is that the integrity of the diaphragm is complete with lipoma while Bochdalek hernias present with a V-shaped discontinuation of the diaphragm. 20,39 There is one case report of liposarcoma in the literature. The CT appearance of the liposarcoma of the diaphragm was a heterogeneous enhancing solid lesion with fat and septae of connective tissue.…”

“…37 However, in symptomatic patients or asymptomatic patients with concern for liposarcoma, the lesion should be resected. 39,40 There may be no defining features of one over the other and differentiating lipoma from liposarcoma may require histologic examination of the lesion.…”

Diaphragmatic lipoma in a 4-year-old girl: a case report

“…The first case was reported by Clark [3] at autopsy. Since then, only 35 cases of diaphragmatic lipoma have been reported [4][5][6][7][8][9][10][11][12][13]. Wiener and Chou [4] reviewed 71 primary tumors of the diaphragm from the literature and reported a 1.6:1 ratio of benign to malignant tumors of the diaphragm.…”

“…Most diaphragmatic lipomas are found incidentally. They occasionally manifest as coughing, dyspnea, chest pain, heart disturbances, or even death caused by a diaphragmatic rupture [5][6][7][8]. A CT scan can demonstrate masses in most patients and can show the characteristic homogenous fat density of these tumors.…”