Pleural lipoma

Last revised by Arlene Campos on 21 May 2024

Pleural lipomas are the most common benign soft tissue tumor of the pleura. These lesions are thought to originate from the submesothelial layers of the parietal pleura, extending into the subpleural, pleural, or extrapleural space. Pleural lipomas are encapsulated fatty tumors with a slow growth rate.

Normally asymptomatic and detected incidentally. In some cases, it causes pleural irritation with an urge to cough. When large, it can cause chest heaviness, dyspnea and breathlessness 7.

  • well-defined, convex lesions forming obtuse angles with the pleura

  • normally vertically oriented in relation to the chest wall

  • no rib erosion

  • appears denser than fat because of interface with air in the lung

  • homogeneous fat density or fat signal intensity

  • no enhancement

They are thought to never transform into a sarcoma. Traditionally, management consisted of either doing nothing or observation. It has been suggested that this stance should be reconsidered due to their potential to grow, and due to the advances in video-assisted thoracic surgery 2,3.

The principal differential diagnoses are those of single pleural masses. However, fat-containing lesions of the chest (e.g. hamartoma) should also be considered.

Extrapleural fat represents fat outside the parietal pleura. It is part of the loose connective tissue of the endothoracic fascia, most abundant along the posterolateral aspects of the 4th through 8th ribs. Extrapleural fat is typically bilateral, symmetrical, and located along the mid-lateral chest wall 1.

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