Postoperative mediastinal lipomatosis

Abstract

MOTS CLES Lipomatose ; Mediastin ; Pontages aorto-coronariens ; Scannner A 53-year-old male smoker with high-blood pressure and a family history of coronaryartery disease, but who was not overweight, was hospitalized for non-ST-elevation acutecoronary syndrome. The initial chest X-ray showed merely a small widening of the anterior and superior mediastinum (Fig. 1). The patient underwent coronary angiography under glycoprotein IIb/IIIa inhibitor therapy, which revealed two lesions: a tight stenosis (90%) in the proximal-anterior interventricular branch of the left coronary artery and a lesion in the right coronary-artery (70%). We decided to perform double coronary artery bypass graft. The follow-up was incidence-free. It must be pointed out that the patient had never been treated with glucocorticoids. Two months after the intervention, the patient consulted again for atypical chest pain with neither modification of the electrocardiogram nor a rise in troponin level. Chest Xray (Fig. 2) revealed superior-right mediastinal enlargement and a right-mediastinal mass with smooth borders (initially suggesting aneurismal-aortic dilation or aortic dissection). An emergency chest angioscan was performed. The examination ruled out aortic dissection and revealed a regular-shaped mass of homogeneous density, close to − 100 Hounsfield units, confirming a diagnosis of anterior-mediastinal nodular lipomatosis, very probably secondary to the recent surgery. Transthoracic echocardiography revealed a 9-mm-thick pericardial effusion, the source of the chest pain. This was treated medically with total relief of the patient’s symptoms.