Spontaneous hemomediastimun is a rare event, occurring in association with
bleeding disorders, intratumoral bleeding, or following an abrupt increase
in intrathoracic pressure. We report the case of a patient with systemic lu
pus erythematosus, nephrotic syndrome, and renal failure, in whom mediastin
al lipomatosis (ML) developed following increased corticosteroid therapy, A
nticoagulant therapy likely precipitated a massive spontaneous hemomediasti
num secondary to diffuse hemorrhage of mediastinal fat, which required emer
gency decompressive surgery, Steroid-induced Mi, is common and usually well
tolerated, but clinicians should be aware of its potential risk of bleedin
g when associated with anticoagulant therapy. This case further emphasizes
the bleeding complications of treatment with low-molecular-weight heparin i
n patients with renal failure.