Lipoma between heart, esophagus is rare and tricky
Dr. Keith Roach
Question: My husband has been diagnosed with a lipoma that is located between his heart and esophagus. It is approximately 4 inches by 6 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 CAT scan together and said that they didn’t know.
My question to you is, Do you know if this is a possibility? — P.M.
Answer: A lipoma, a benign fatty tumor, is very rarely found in the mediastinum that’s the anatomic name for the part of the chest cavity that includes the 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 would 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 that it is stable in size, I would be reluctant to recommend a very invasive surgery.
I could not fifind anything on using liposuction. All cases in the literature I found used a standard open surgical technique.
Q: Results from a recent yearly checkup showed an abnormal microalbumin- to-urine-creatinine ratio. My level last year was 0.5, and now it is 6.5. I am concerned about the spike in results and wonder if this is something about which I should be concerned. I am 81, health and take metformin and lisinopril. D.D.
A: The microalbuminto-urine-creatinine ratio is a screening test for large amounts of protein developing in the urine proteinuria). It is used mostly in people with diabetes (which I assume you have or are at high risk for). 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.
Even though you had a large increase, your level is normal, you are on appropriate medication, your diabetes is under control, and I do not think you need to worry about this result.