Lipoma of the Right Thoracic Inlet With Intravascular Extension and Fatty Thrombus Into the Right Brachiocephalic Vein

A 61-year-old man was admitted for a persistent fever. A work-up led to a final diagnosis of urinary infection, but a whole-body computed tomographic scan revealed a large (41 23 mm), well-defined mass of fat-equivalent density ( 89 Hounsfield Unit) in the right thoracic inlet space. The lesion clearly invaded the right brachiocephalic vein, and a fatty neoplastic thrombus completely occluding the vessel up to the Pirigoff confluent was evident (Figs 1A, 1B). A preoperative histologic sampling was deemed unfeasible because of the localization of the mass, but the radiologic features (vascular invasiveness and association with a fatty thrombus) were highly suggestive of malignancy. Therefore, after the treatment of infection, surgery was planned. A right cervicothoracic, inverted L–shaped incision with upper sternal split and anterior thoracotomy was performed. The tumor appeared strictly adjacent to but not invasive