Mediastinal Widening due to Lipomatosis and Herniated Liver and Stomach

Abstract

A Al-Adsani, MH Dahniya, A Al-Beltagi, Mediastinal Widening Due to Lipomatosis and Herniated Liver and Stomach. 2000; 20(3-4): [288][289][290] Mediastinal widening on a conventional chest radiograph is a common and often challenging clinical problem. It may be due to a number of conditions, which may either be benign or malignant, normal or unusual. Computed tomography (CT) is now the initial, and in most instances, the definitive imaging modality for evaluating a widened mediastinum. We report here a case of an obese woman in whom mediastinal widening was due not only to mediastinal lipomatosis, but also to a large anterior abdominal wall defect through which the stomach and liver had herniated. We also briefly review some aspects of mediastinal widening. Case ReportA 51-year-old hypertensive woman presented with a one-month history of progressive exertional dyspnea, snoring and inability to lie flat. She gave a three-year history of assumed bronchial asthma, for which she was irregularly taking inhaled bronchodilator and steroids. Clinical examination revealed a very obese woman (weight 110 kg), with a need to sit in a propped up position. Her blood pressure was 150/90 mm Hg, and there were no other abnormal findings in the cardiovascular and respiratory systems. The abdomen was fatty and pendulous, with a supraumbilical hernia and a lower abdominal cesarian scar. Hematological and biochemical investigations were all normal, except for fasting serum glucose of 7.1 mmol/L (normal 3.9-6.1) and total cholesterol of 5.32 mmol/L (normal 3.9-5.2). The ECG record showed a sinus regular rhythm with inverted T in L1 and aVL. A posteroanterior chest radiograph revealed moderate cardiomegaly, a dilated and unfolded aorta, narrowing of the coronal diameter (9.6 mm) of the intrathoracic portion of the trachea (normal range 14.4 to 18.2 mm in women), with a slight tracheal shift to the right and widening of the mediastinum (Figure 1), which was further evaluated by contrast-enhanced CT scan. Conventional 10 mm axial images were acquired from apex to base on a helical scanner (GE Sytex 2000, GE Medical Systems, Milwaukee, USA), following intravenous injection of 100 mL of Omnipaque (350 mgI/mLNycomed). CT of the chest showed the excessive fat surrounding the upper and mid-mediastinal structures ( Figures 2 and 3, respectively). In addition to the obvious mediastinal and abdominal lipomatosis, there was a large defect of the upper anterior abdominal wall (remote from the lower cesarian scar), through which a large part of the liver and stomach had herniated (Figures 4 and 5). These herniated structures were contributing significantly to the mediastinal widening in addition to the lipomatosis. There was cardiomegaly but the lungs were normal. Echocardiogram revealed normal systolic and impaired diastolic function of the left ventricle (ejection fraction was 70%), with left ventricular hypertrophy, mild mitral regurgitation, and mild enlargement of left atrium. She was advised to reduce her weight, and her blood pressure was ...

Immunities of State Officials, International Crimes, and Foreign Domestic Courts: A Reply to Dapo Akande and Sangeeta Shah

“…In Al-Adsani the UK Government did not afford the claimant diplomatic protection against Kuwait, and then argued before the Strasbourg Court that the proper way of obtaining remedies was diplomatic representation. 34 Al-Adsani was left without any remedy, and so were victims in Jones, much as the Law Lords asserted that all they decided was to divert settlement to other means, 35 which is said to be the purpose of immunities. 36 This approach rang hollow, for it ensured that the victims never got any remedy and Saudi Arabia was never held responsible.…”

Mediastinal Widening Due to Lipomatosis and Herniated Liver and Stomach

“…To the Editor: We read with interest the article of Dr. Al-Adsani et al 1 We experienced a similar case of a mediastinal lipomatosis of a 34-year-old man whose chest x-ray showed a huge pseudocardiomegaly (Figure 1). 2 CT scan revealed a large mass (Figure 2) of fatty attenuation (100-120 Hounsfield units) involving the mediastinal space from the T3 level to the hemidiaphragm.…”

State Immunity in National and International Law: Three Recent Cases Before the European Court of Human Rights

“…30 But in Al-Adsani, the Court tolerated that state immunity resulted in an absolute bar of consideration of the applicant's claims in the British courts without providing the applicant with any compensation or alternative remedy; in addition, the United Kingdom had refused to assist Al-Adsani in obtaining compensation from Kuwait through diplomatic protection. 31…”