Postoperative Chest Pain Unmasking a Subcarinal Mediastinal Lipoma

Mediastinal lipomas are rare lesions that are often missed on chest radiographs.A healthy 45-year-old male (ASA I) developed acute chest pain with palpitations in the post-anesthesia care unit after uncomplicated renal surgery.Examination, chest radiograph, and biomarkers were normal and ECG showed sinus tachycardia.The symptoms resolved with low-flow oxygen.CT/MRI the following day revealed a subcarinal fat-density mass (~6 × 5 × 8 cm) causing mild left-atrial compression.Bronchoscopy was normal; needle aspiration confirmed mature adipose tissue, consistent with lipoma.Surgery was advised but declined.This case underscores a structural cause of postoperative chest pain and the value of early cross-sectional imaging when initial evaluation is nondiagnostic.