200 AJTCCM VOL. 28 NO. 4 2022
PICK OF THE PICS
A 64-year old male, with diabetes mellitus,
presented to the emergency room with
atypical chest pain. A chest radiograph
revealed a widened mediastinum with a hazy-
grey appearance alongside the ascending
aorta and right cardiophrenic area, through
which the bronchovascular structures can
be visualised. ese features are consistent
with mediastinal lipomatosis. Mediastinal
widening is considered present when the
mediastinal width exceeds 8 cm measured at
the aortic arch. Other causes of mediastinal
widening (Table 1) have specic radiological
features. A CT scan showed excessive
mediastinal tissue with Hounseld units of
-50 to -100, consistent with adipose tissue.
Mediastinal lipomatosis is a benign condition
characterised by the presence of excessive fat
deposition in the mediastinum, and should
be considered when the above radiological
features are encountered with obesity, steroid
use, alcoholism, Cushing’s syndrome and
diabetes mellitus.
This open-access article is distributed under
Creative Commons licence CC-BY-NC 4.0.
What is the cause of this widened mediastinum?
D P Boy, MBChB (Stell), Dip Int (SA), FCP(SA)
Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
darrylpeterboy@gmail.com
Table 1. Causes of mediastinal widening
(Traumatic) Aortic dissection Mediastinal lymphadenopathy
Vascular anomalies Enlarged pulmonary arteries
Unfolded Aorta Mediastinal masses
Double superior vena cava ymus
Aberrant right subclavian artery Diaphragmatic hernia
Azygos continuation of the IVC Technical factors
Lung Rotation
Atelectasis/Lung collapse Poor inspiration
Pulmonary masses abutting mediastinum Supine position
Mediastinal Lipomatosis
