Pleural and Mediastinal Lipomatosis with Subpleural Fat as a Mimicker of Pleural Effusion- A Rare Case Report

Abstract

A 58-year-old male patient came to our hospital with complaints of breathlessness and dry cough since 10 days. He was suffering from congestive cardiac failure and bilateral pedal oedema in the past and he was taking prednisolone 30 mg since last two years for the same. After that he was referred to Radiology Department for further evaluation. X-Ray and CT scan of chest were done. On X-ray, superior mediastinum widening was seen and bilateral upper zones appear hazy with blunting of left costophrenic angle was seen mimicking as pleural effusion [ AbSTRACTSubpleural and mediastinal lipomatosis are benign intrathoracic conditions discovered incidentally on plain chest radiographs. However, diagnosis is usually made by Computed Tomography (CT). A case of both mediastinal and pleural lipomatosis associated with use of steroids in a 58-year-old male patient presented with complaints of breathlessness and dry cough is discussed in this case report. Intially, pleural effusion and bilateral upper lobe patchy opacities were suspected as a cause of breathlessness on the basis of chest x-ray findings. For which, CT scan of chest was advised.

Dyspnoea and restrictive lung disease due to mediastinal and pleural lipomatosis in morbid obesity

“…While mediastinal lipomatosis is relatively common, simultaneous occurrence of both mediastinal and pleural lipomatosis is rare. We can only find one other case of mediastinal lipomatosis in association with pleural lipomatosis in the literature .…”

“…Surgical treatment is generally definitive with a low incidence of recurrence. Transformation of pleural lipomatosis into sarcoma is rare .…”

Idiopathic Mediastinal Lipomatosis Presenting as Pulmonary Embolism: A Rare Case Report.

“…Mediastinal lipomatosis is a relatively common benign cause of mediastinal widening [3]. It is the result of an excessive proliferation of mature fat cells.…”

“…Mediastinal lipomatosis is usually asymptomatic and fortuitously discovered. However, it can become compressive and cause cough, dyspnea even respiratory distress, chest pain, dysphagia, cardiac arrhythmia or superior vena cava syndrome [2][3][4][5]. Our patient had acute chest pain with dorsal irradiation.…”

“…In the case the patient is obese, weight loss is strongly recommended [5]. Tapering off steroids is usually needed in steroid induced lipomatosis [3]. However, in case of symptoms related to mass effect, complete surgical resection or surgical reduction may be necessary [12], as in the case presented by Nguyen et al [13].…”