• bilateral mediastinal tumour
• dumbbell tumour
• lipoblastoma

A 6 month old male infant presented with fever and cough of one month duration. The chest radiograph showed bilateral radio-opacities occupying the medial aspect of each hemithorax (fig 1). Computerised tomography (CT) revealed a dumbbell shaped tumour occupying both hemithoraces (fig 2). The tumour was continuous across the midline by an isthmus passing posterior to the descending aorta and displacing the oesophagus anteriorly. The tumour had fat and soft tissue attenuation and did not enhance significantly. It was completely excised by bilateral posterolateral thoracotomy. Postoperative recovery was uneventful. Lipoblastoma was diagnosed on histopathology.

Lipoblastoma is a rare tumour of embryonal fat that occurs almost exclusively in children under the age of 3 years.¹ The tumour presents as a localised, well circumscribed lesion known as lipoblastoma or a diffuse/multicentric form known as lipoblastomatosis.² Most lesions present as a subcutaneous soft tissue mass on the extremities or head and neck. Truncal lesions are less common.³ Focal tumours behave in a benign manner and diffuse lesions may recur if incompletely excised.¹ To our knowledge, only five patients with mediastinal lipoblastoma have been reported in the literature.² This is the only instance of a dumbbell shaped mediastinal tumour occupying both hemithoraces.

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Figure 1

Anteroposterior chest radiograph showing bilateral hilar radio-opaque shadows.

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Figure 2

CT scan showing a dumbbell shaped mediastinal tumour with fat and soft tissue attenuation. The tumour is compressing both lungs and displacing mediastinal structures anteriorly.