Spontaneous hemomediastinum is a rare event, occurring in
association with bleeding disorders, intratumoral bleeding, or
following an abrupt increase in intrathoracic
pressure. We report the case of a patient with systemic lupus
erythematosus, nephrotic syndrome, and renal failure, in whom
mediastinal lipomatosis (ML) developed following increased
corticosteroid therapy. Anticoagulant therapy likely precipitated a
massive spontaneous hemomediastinum secondary to diffuse hemorrhage of
mediastinal fat, which required emergency decompressive surgery.
Steroid-induced ML is common and usually well tolerated,
but clinicians should be aware of its potential risk of bleeding when
associated with anticoagulant therapy. This case further emphasizes the
bleeding complications of treatment with low-molecular-weight
heparin in patients with renal failure.