Sub-Pleural Fibrolipoma: Report of Case

Abstract

Patient, Miss G., aged forty-nine, white, weighing about ninety pounds, employed as a matron at city comfort station. Referred by Dr. J. G. Hemington for X-ray examination of chest, July 3, 1924. Chief complaint: Shortness of breath upon slight exertion or when in a crowd. First noticed this condition persisting following an attack of influenza and congestion of lungs in January, 1921. Had pleurisy of left side in March, 1924, and was sick about ten days. Had pleurisy of left side again in June, 1924, and was in bed this time about a week. There has been no loss of weight. Appetite always poor, tires very easily. No history of tuberculosis or malignancy in the family. Blood Wassermann negative. Patient was poorly nourished, of a sallow, muddy complexion, and slow in speech and movement. Roentgen-ray findings July 3, 1924: Dense, sharply outlined spherical mass, measuring about 12½ cm. in diameter, located at base of left posterior chest between the levels of the fifth rib and the eleventh interspace. It shows no evidence of invading the remaining parts of the chest and appears to be arising from the left side of the vertebral border of the chest cavity. Fluoroscopically it is fixed, does not move with respiration, does not pulsate, nor does it displace the heart shadow. The lung appears to glide about it with respiration. Conclusions: Cyst of left chest attached to left side of spinal column. Patient was re-examined July 14, 1924, eleven days after the first examination, and condition was unchanged. She was again examined on January 17, 1925, practically six months after the first examination, and there was no perceptible change in the size or shape of the mass. Following this third X-ray examination the patient was referred to Dr. F. S. Morris, of the Homeopathic Hospital, Pittsburgh, Pa., for operation. Pathological diagnosis made by Dr. J. G. Wurtz, Pathologist of the hospital: Sub-pleural fibrolipoma. This diagnosis was confirmed by members of the Clinical-Pathological Society of Pittsburgh, when the tumor, X-ray films, and microscopic sections were shown at a recent meeting. Six months following the operation, radiograms of the chest showed resection of the sixth, seventh, eighth and ninth ribs at the posterior angle on the left side, with no evidence of the previously existing tumor, lungs and mediastinum being normal. Patient, however, showed no increase in weight and her general physical appearance was unchanged. The writer wishes to express his appreciation to Dr. J. G. Hemington, of Uniontown, Pa., for the privilege of reporting this case, and also to Dr. E. H. Pond, Radiologist of the Pittsburgh Homeopathic Hospital, for supplying him with a copy of the pathological findings.