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Spontaneous Hemomediastinum Complicating Steroid-Induced Mediastinal Lipomatosis*

Camille Taillé, MD; Muriel Fartoukh, MD; Rémi Houël, MD; Hicham Kobeiter, MD; Philippe Rémy, MD; François Lemaire, MD
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*From the Service de Réanimation Médicale (Drs. Taillé, Fartoukh, and Lemaire), Service de Chirurgie Cardiaque (Dr. Houël), Service de Radiologie (Dr. Kobeiter), and Service de Néphrologie (Dr. Rémy), Hôpital Henri Mondor, Créteil, France.

Correspondence to: François Lemaire, MD, Service de Réanimation Médicale, Hôpital Henri Mondor & Université Paris 12, 94000 - Créteil Cedex, France; e-mail: francois.lemaire@hmn.ap-hop-pari.fr



Chest. 2001;120(1):311-313. doi:10.1378/chest.120.1.311
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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.

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