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A Case of Bulky Intrathoracic Lipoma Masquerading as Left Hemidiaphgram Paralysis FREE TO VIEW

Shanthakumari Jinnur*, MD; Viswanath Vasudevan, MD; Praveen Jinnur, MD; Mahmoud Dakhel, MD; Kenneth Ong, MD
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The Brooklyn Hospital Center, Brooklyn, NY

Chest. 2012;142(4_MeetingAbstracts):579A. doi:10.1378/chest.1380464
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SESSION TYPE: Cancer Student/Resident Case Report Posters

PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM

INTRODUCTION: Lipomas are common benign tumors occurring mostly in subcutaneous tissue, but are rarely seen in the thoracic cavity arising from mediastinum, pericardium or pleura. Most intrathoracic lipomas are asymptomatic, found incidentally on a chest X-ray and may be confused with malignant tumors. We describe a 96 year old lady who presented with dyspnea and an elevated left hemidiaphragm on chest x-ray. CT scan revealed the characteristic fat density of lipoma.

CASE PRESENTATION: 96 year old lady with a medical history of hypertension, diabetes mellitus, and sick sinus syndrome with bipolar pacemaker implantation was admitted for shortness of breath. She had exertional shortness of breath and denied any cough, fever or chest pain. Vital signs on admission were BP-166/100, HR-86, Resp Rate-20/min and 97% on pulse oximetry on room air. Physical exam was significant for decreased air entry in the left lung base. Laboratory findings were within normal limits. Chest X-ray was as shown (Fig.1). CT angiogram of chest ordered by ED team didn’t show any evidence of pulmonary embolism, but revealed a large intrathoracic mass on the left side with compressive atelectasis of the left lower lobe. The mass measured 11cm x 9cm x 7cm (Hounsfield unit-110) and likely representing a fatty tumor. Patient refused further evaluation of the mass. She improved clinically and was discharged in 24 hours.

DISCUSSION: Intrathoracic lipomas are often asymptomatic and discovered incidentally. Liposarcomas rarely occur in the thorax; their attenuation coefficient is higher than -50 units and density of the lesions is heterogeneous. Excision of bulky benign lipoma can help alleviate dyspnea. Cases of successful removal of large intrathoracic lipomas have been reported. However, a possible infiltrating growth may make an operation more complicated even if they are histologically benign. A strategy for the management of asymptomatic intrathoracic lipomas has not been established. Patients might need a close follow-up over years. However, little is known about the clinicopathological features of intrathoracic lipomas because there have been few reports on it in the literature. Some recommend cytogenetic studies for distinguishing lipomas from malignant lesions. Characteristic tumor-specific chromosomal abnormalities have been noted in ordinary lipomas. Our patient preferred not to have any further work up and at her age we felt it was a right decision considering the risks of surgery involved.

CONCLUSIONS: Intrathoracic lipomas are usually asymptomatic and many reports in literature are usually cases which were discovered incidentally. Many of these cases do not need surgical management. However a close follow-up should be recommended in all cases. Liposarcomas rarely occur in the thorax.

1) Intrathoracic Lipomas: Their Clinicopathological Behaviors Are Not As Straightforward as Expected. Hiroyuki Sakurai, Masahiro Kaji, Kazuto Yamazaki, Keiichi Suemasu Ann Thorac Surg 2008;86:261-265.

DISCLOSURE: The following authors have nothing to disclose: Shanthakumari Jinnur, Viswanath Vasudevan, Praveen Jinnur, Mahmoud Dakhel, Kenneth Ong

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The Brooklyn Hospital Center, Brooklyn, NY




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