Rare lipoma near heart can be tricky to remove
Dear Doctor: My husband has been diagnosed with a lipoma that is located between his heart and esophagus. It is approximately four inches by six inches in size. The surgeon said he has never seen one in this location in all of his 50 years of practice. It is not currently a health issue and has not changed in size in the past 18 months. When the doctor described the extensive surgery that would be needed to remove the lipoma, I asked if it could be removed with liposuction, as this is the procedure apparently used for removing lipomas that are close to the surface. He and another surgeon looked at the CT scan and said they didn’t know. My question is, Do you know if this is a possibility? They said if they used liposuction, they may not get it all. What difference would that make as long as it was smaller, with no chance of pushing into the heart or esophagus? My husband is 70 and in fairly good health otherwise. — P.M.
A: A lipoma, a benign fatty tumour, is rarely found in the mediastinum (part of the chest cavity that includes heart and esophagus).
The question I have is, why are they considering removing it? It is certainly a large size, but if it isn’t causing problems, I’m not sure why they’d want to intervene. I reviewed the literature on lipomas, and they are removed only when they are already compressing an important structure, such as the heart or a large blood vessel, or when the diagnosis isn’t clear. Given it is stable in size, I would be reluctant to recommend a very invasive surgery.
I couldn’t find anything on using liposuction. All cases used an open surgical technique. One study noted this was the only way of removing the entire tumour. Dear Doctor: Results from a recent yearly checkup showed an abnormal microalbumin-tourine-creatinine ratio. My level last year was 0.5, and now it is 6.5. I am concerned about the spike and wonder if this is something about which I should be concerned. I am 81, healthy and take metformin and lisinopril. My A1C level was 6.0 per cent. — D.D.
A: The microalbumin-to-urinecreatinine ratio is a screening test for large amounts of protein developing in the urine (proteinuria). It is used mostly in people with diabetes. Albumin is the major protein found in urine in people with kidney disease.
A ratio of 6.5 is still very low. Normal is considered less than 30. Between 30 and 300, people are considered to have “moderately increased albuminuria.” A level over 300 is called “severely increased albuminuria,” and people with this are at high risk for progressive kidney disease.
Most specialists recommend an ACE inhibitor, like lisinopril, to prevent kidney damage in the first place. Though you had a large increase, your level is normal, and I do not think you need to worry about this result.