Pleural lipomatosis: An often-forgotten intrathoracic tumor

Abstract

Lipomas are benign mesenchymal neoplasms that arise from adipocytes. Most lipomas are found in the subcutaneous tissue; however, they can be present throughout the body. Lipomas arising from the thoracic pleura are exceptionally rare, with only approximately 20 cases ever reported in the literature. While typically asymptomatic, pleural lipomas may cause compressive symptoms such as nonproductive cough, chest pain, and dyspnea if they reach adequate size. A CT scan is usually sufficient for the diagnosis and typically reveals well-defined nodules with homogenous fat attenuation of approximately -50 to -150 Hounsfield units. Management is dependent on various factors including tumor size and location, associated symptoms, and age of the patient. Pleural lipomatosis, although exceedingly rare, should be maintained in the differential diagnosis for any well-defined, fat-attenuating pleural mass identified on conventional radiologic studies. Here we report a case of pleural lipomatosis associated with bilateral pleural effusions identified in an 83-year-old male presenting with acute onset dyspnea.

Keywords: Dyspnea; Intrathoracic tumor; LIPOMA; Pleural effusion; Pleural lipomatosis; Thoracic pleura.

Fig. 1

Frontal chest radiograph showing an enlarged cardiomediastinal shadow with mild prominence of the pulmonary vasculature. There is slightly increased opacity at both lung bases.

Fig. 2

Axial computed tomography scan showing small bilateral pleural effusions with multiple, well-defined interspersed nodules of fat attenuation (−98 HU).

Fig. 3

Frontal computed tomography scan demonstrating a large nodule of fat attenuation in the inferomedial aspect of the left hemithorax measuring 6.2 × 3.3 cm in greatest dimension.