CTICasesExuberant Mediastinal Fat Necrosis after Lung Transplant
Imaging findings
A patient after clamshell (bilateral) lung transplant has striking inflammatory changes in the mediastinal fat on early post-operative CT that, a couple of weeks later, evolved into exuberant fat necrosis with a calcified edge, while the chest wall inflammation improved. The sternotomy site appeared somewhat unhappy, raising the possibility of a low-grade infectious contribution.
Key takeaways
Mediastinal fat necrosis can develop exuberantly after clamshell lung transplantation, presumably from surgical manipulation of the pericardium/epicardium, evolving from marked mediastinal fat inflammation into a fat-necrosis mass with a calcified rim. Recognizing the fatty content and calcified edge identifies it as benign fat necrosis rather than a soft-tissue mass, and it typically progresses and stabilizes over subsequent months.
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