Surgical resection of pleural lipoma after 9 years of serial imaging

Pleural lipomas are rare benign intrathoracic mesenchymal neoplasms. Although typically asymptomatic, they can enlarge and cause symptoms secondary to compression of surrounding intrathoracic structures. There is minimal reporting of pleural lipoma observed with computed tomography throughout prolonged periods of surveillance; therefore, differentiating well-differentiated malignant liposarcoma from imaging alone remains a diagnostic challenge. We present the case of a 74 year-old male with tobacco use and asbestos exposure who underwent surveillance of a pleural neoplasm over 9 years. Continued enlargement and morphological changes concerning for malignancy prompted video-assisted thoracoscopic surgical resection. The pleural mass was diagnosed as a pleural lipoma and the patient recovered well. Pleural lipomas, especially in patients with risk factors for malignancy, should be resected for accurate diagnosis and prevention of complications associated with compression of adjacent structures.