Abstract Introduction Mediastinal lipomatosis is a rare benign tumor, comprising only 1.6-2.3% of all primary mediastinal tumors (2017), with a preference for the anterior mediastinum. Coexisting pleural lipomatosis is even rarer, with only a few cases reported. We present a case of an elderly man with cough, chest discomfort, and facial plethora, later diagnosed with both mediastinal and pleural lipomatosis. Case A 63-year-old Filipino male, a 57 pack-year smoker, presented with acute chest discomfort radiating to the left shoulder, on a background of a one-year chronic cough. He denied other symptoms and had no prior workup. His history included hypertension and poorly controlled diabetes mellitus, managed with Amlodipine, Metformin, and Glimepiride. On examination, he was hemodynamically stable (BP 100/80 mmHg, HR 86 bpm), tachypneic (23 breaths/min), with oxygen saturation of 95% on room air. His face was plethoric with a positive Pemberton sign. Central obesity with disproportionate limbs and bilateral basal crackles (more on the left) were noted. Chest radiograph revealed a homogeneous density in the left upper lobe (4.0 × 4.8 × 4.8 cm) with fissural bulging, suggesting pneumonia or a pulmonary mass. Chest CT showed excessive mediastinal fat involving the anterior and left posterior mediastinum, causing narrowing of the left brachiocephalic vein and superior vena cava, without lymphadenopathy or compressive mass. Prominent collateral vessels were seen in the cervicothoracic and left anterior chest regions. The patient denied steroid use but had poorly controlled diabetes. Further workup confirmed Cushing’s syndrome. He was started on appropriate therapy and advised weight reduction. On follow-up, he demonstrated weight loss, resolution of facial plethora, and regression of both mediastinal and pleural lipomatosis. Discussion Obesity affects respiratory health through reduced lung volume, decreased compliance, and increased cardiovascular risk, leading to poor exercise tolerance. Some studies also suggest abnormal central respiratory regulation in obesity. While mediastinal fat deposition is uncommon, the simultaneous presence of pleural lipoma is exceedingly rare and may mimic pleural effusion. Chest CT is crucial for distinguishing these conditions. Management is generally conservative, focusing on weight reduction and treatment of underlying causes such as Cushing’s syndrome, which can result in significant regression of lipomatous deposits and improved respiratory function. This abstract is funded by: None
Valiente et al. (Fri,) studied this question.