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OBJECTIVE: Huge lipoma in the anterior mediastinum can be extremely crippling. The optimal therapy is surgical removal of the tumor en block or as much possible without causing undue harm to underlying structures. Herein we present a case where we removed a 14 kg lipoma from the anterior mediastinum.
METHODS: A 57 year female presented with massive swelling in the neck and mediastinum with complaints of breathlessness for past 4 years along with restricted mobility. Chest x-ray showed large soft tissue shadow with mixed lucency occupying mid-lower zones of both lung fields. PFT showed Severe Restrictive Lung with FVC-0.64 FEV1- 0.49(PRE) 0.56(POST). CT- Showed large fat attenuating anterior mediastinal mass extending in bilateral hemi thorax. MRI showed large fat intensity anterior mediastinal lesion with few fibrous strands in it causing mass effect on bilateral lungs.COMBINED APPROACH-Mediastinal mass removed via midline sternotomy and cervical extension of the mass removed by a seperate horizontal incision by Onco Surgical team. Histological examination confirming the diagnosis of giant intrathoracic lipoma weighing 14 kg with diffuse lipomatous infiltration of thyroid gland.
RESULTS: Patient remained intubated for 4 days for the lungs to get expanded.Post removal patient respiration improved saturating 95% on nasal prongs with no respiratory compromise.Chest tubes were kept for 6 days to avoid collection in dead spaces. Patient was discharged home on post op day 15.Three months post excision her quality of life improved remarkably.
CONCLUSIONS: Crippling mediastinal mass needs thorough examination and multidisciplinary approach for the management. Removal of such massive tumors improve lung functions and by the same token quality of life.