Chest
Volume 90, Issue 2, August 1986, Pages 265-268
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Medical Imaging
Pleural Lipoma: Diagnosis by Computed Tomography

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Until recently, a definitive diagnosis of lipoma in the thorax could only be established by thoracotomy. We undertook this study to determine if chest CT could provide such an answer. Among 4,000 chest CT scans, six patients were found to have lipoma according to the following selected criteria: (1) CT features of a pleural mass; (2) a lesion showing completely homogeneous density with CT numbers indicating fat, and (3) exclusion of other fatty lesions. In these six patients, the lipoma was an incidental finding, four were men, the mean age was 64.3 years, one-half were obese, and none had chest pains or dyspnea. Lesions varied in size from 2 to 4 cm and occurred along the chest wall. The CT numbers of the masses ranged from −54 to −129. None developed malignancy. In conclusion, we recommend clinical and chest CT follow-up for the asymptomatic patient who fulfills our CT criteria for lipoma. Biopsy or resection is recommended for lesions that are inhomogeneous.

Section snippets

Patients and Methods

We reviewed the data base of some 4,000 chest CT scans from four Boston hospitals from 1978 to 1984 for the mention of “fatty lesions.” We found six that qualified as lipoma according to the following criteria: (1) typical CT features of a pleural mass: a smooth, well-defined border abutting the lungs, tapering margins with the chest wall, and contact with the pleura over at least one quarter of the mass's circumference; (2) the density of the pleural lesion was completely homogeneous and equal

Results

In all cases, the abnormalities were found incidentally as part of a hospital admission film or a baseline study for a rionpulmonary diagnostic evaluation. The mean age was 64.3 years with a range of 55 to 73. Four were men. Fifty percent of the patients were obese. None had chest pain or dyspnea. Two who were smokers had productive cough, one of whom had rhonchi. No pleural rubs or crackles were heard.

The lesions ranged in size from 2 to 4 cm. Five of the six were identified along the lateral

Discussion

Intrathoracic lipoma was first described in 1781. Lipomas occur in the pleura, mediastinum, lung parenchyma, and bronchi, and some may have an “hour glass” appearance.1, 2 Pleural lipomas are generally asymptomatic and often found incidentally on chest roentgenograms. A specific preoperative diagnosis has not been possible, and the only reliable diagnostic method has been exploratory thoracotomy.

The standard chest roentgenogram may not permit accurate localization of focal lesions to the

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