Mediastinal Lipomatosis Research Articles

Steroid induced huge mediastinal lipomatosis

Steroid induced huge mediastinal lipomatosis

The apical cap.

Apical caps, either unilateral or bilateral, are a common feature of advancing age and are usually the result of subpleural scarring unassociated with other diseases. Pancoast (superior sulcus) tumors are a well recognized cause of unilateral asymmetric apical density. Other lesions arising in the lung, pleura, or extrapleural space may produce unilateral or bilateral apical caps. These include: (1) inflammatory: tuberculosis and extrapleural abscesses extending from the neck; (2) post radiation fibrosis after mantle therapy for Hodgkin disease or supraclavicular radiation in the treatment of breast carcinoma; (3) neoplasm: lymphoma extending from the neck or mediastinum, superior sulcus bronchogenic carcinoma, and metastases; (4) traumatic: extrapleural dissection of blood from a ruptured aorta, fractures of the ribs or spine, or hemorrhage due to subclavian line placement; (5) vascular: coarctation of the aorta with dilated collaterals over the apex, fistula between the subclavian artery and vein; and (6) miscellaneous: mediastinal lipomatosis with subcostal fat extending over the apices.

The Use of Computed Tomography to Evaluate Suspected Mediastinal Tumors

Thirty patients with suspected mediastinal tumors were evaluated by computed tomography (CT) at UCLA Medical Center. Twenty patients with myasthenia gravis were examined for possible thymomas, benign and malignant; and 10 patients were studied for other mediastinal masses (including teratoma, seminoma, mediastinal lipomatosis, carcinoma, lymphoma, and paravertebral abscess). The CT scan was found useful in several respects: (1) yielding information not available by conventional radiographic techniques; (2) defining the anatomical location and extent of mediastinal tumors; (3) detecting pulmonary metastasis and involvement of mediastinal nodes in cases of malignancy; and (4) establishing the diagnosis of benign mediastinal fatty masses. On the basis of our early experience, we believe CT is a valuable adjunct in the preoperative assessment of patients with suspected mediastinal tumors.

Ectopic ACTH Production and Mediastinal Lipomatosis

The authors describe a case of mediastinal lipomatosis in a patient with ectopic ACTH production from carcinoma of the lung.

Mediastinal Lipomatosis in Simple Obesity

A case of superior mediastinal widening due to unusual amounts of fat accumulations is reported in a patient with simple obesity, not associated with iatrogenic or primary Cushing's syndrome. The radiographic features included a smooth bilateral widening of the superior mediastinum, relative lucency, no definable mass in the lateral view, and no pressure effects on the trachea. Such mediastinal lipomatosis is a benign condition and may be related to general obesity. although rare, it should be considered in the differential diagnosis of mediastinal masses, particularly in obese individuals.

The spectrum of drug-induced pulmonary disease.

The relationship between the use of various drugs and pulmonary disease is being recognized with greater frequency. The means whereby drugs can cause pulmonary disease vary widely and are not well understood. Drugs such as nitrofurantoin, busulfan, methysergide, the ganglionic blockers, pituitary snuff, and sulfonamides and drugs producing the systemic lupus erythematosus syndrome probably incite a hypersensitivity pulmonary reaction. Corticosteroids are most commonly associated with the proliferation of opportunistic organisms and with mediastinal lipomatosis. Aerosolized drugs, such as cromoglycate disodium, isoproterenol, and orally ingested aspirin and propranolol, can cause bronchospasm in some persons. Pleural effusion can be caused by nitrofurantoin, methysergide, and drugs inducing systemic lupus erythematosus. Respiratory muscle paralysis has been associated with the use of neomycin, gentamicin, and other antibiotics. Many drugs can produce pulmonary disease directly or indirectly, and it is extremely important to recognize this and take a careful drug history.