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

Abstract

Subpleural 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.

Keywords: CT scan; Lipoma; Pleural effusion.

[Table/Fig-1]:

Chest x-ray shows superior mediastinal widening with hazy bilateral upper zones and blunting of left costophrenic angle mimicking as pleural effusion (indicated by marker).

[Table/Fig-2]:

Coronal CT image shows blunting of left costophrenic angle due to pleural fat (indicated by marker).

[Table/Fig-3]:

Axial CT images show fat attenuating region around the pleura and mediastinum suggestive of pleural and mediastinal lipomatosis (indicated by marker in 3a,3b,3c) and a small patch of consolidation was seen in superior segment in left lower lobe (marked by star mark in 3c).

[Table/Fig-4]:

Photomicrograph of the biopsy material (stained with haematoxylin and eosin with 4x resolution) shows well-differentiated adipocytes consistent with diagnosis of lipoma.