Mediastinal Widening in Iatrogenic Cushing's Syndrome

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Abstract
Attention is called to a previously unrecorded manifestation of iatrogenic Cushing''s syndrome. Two cases are presented which demonstrate roentgenologic, surgical, and autopsy evidence that mediastinal widening due to fat occurred during the course and as one of the features of corticosteroid therapy. This entity is characterized by: Iatrogenic Cushing''s syndrome. A slowly evolving, asymptomatic mediastinal widening. An appearance of prominent epicardial fat pads coincident with the mediastinal widening and other manifestations of hypercorticism. A decrease or disappearance of all of these features when corticosteroids are withdrawn. One of the patients had asthma and eventually underwent exploratory thoracotomy because of undiagnosed mediastinal widening. Proper recognition of this unusual feature of iatrogenic Cushing''s syndrome may spare this group of patients unnecessary chest surgery.