Anesthetic considerations in steroid-induced mediastinal lipomatosis

Mediastinal lipomatosis (ML) is a benign condition characterized by circumscribed overgrowth of adipose tissue producing mediastinal widening that can cause errors in diagnosis on chest roentgenogram. We describe a case of steroid-induced ML leading to difficulty in central venous catheterization during surgery and its other implications for anesthesiologists. Because many patients receive long-term steroid administration and present for surgical intervention, it is essential that they undergo detailed preoperative evaluation to exclude Cushing's syndrome and various pressure effects. IMPLICATIONS: This case report highlights problems during right internal jugular vein cannulation resulting from high back pressure and flow from superior vena cava obstruction in steroid-induced mediastinal lipomatosis. Other anesthetic considerations in mediastinal lipomatosis are also discussed.