Spontaneous Hemomediastinum Complicating Steroid-Induced Mediastinal Lipomatosis

Spontaneous hemomediastinum is a rare event, occurring inassociation with bleeding disorders, intratumoral bleeding, orfollowing an abrupt increase in intrathoracicpressure. We report the case of a patient with systemic lupuserythematosus, nephrotic syndrome, and renal failure, in whommediastinal lipomatosis (ML) developed following increasedcorticosteroid therapy. Anticoagulant therapy likely precipitated amassive spontaneous hemomediastinum secondary to diffuse hemorrhage ofmediastinal fat, which required emergency decompressive surgery. Steroid-induced ML is common and usually well tolerated, but clinicians should be aware of its potential risk of bleeding whenassociated with anticoagulant therapy. This case further emphasizes thebleeding complications of treatment with low-molecular-weightheparin in patients with renal failure.