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Mediastinal abnormalities can present a challenging differential diagnosis. One of the many causes of superior mediastinal widening is excess deposition of fat or mediastinal lipomatosis. Mediastinal widening was evaluated by routine chest radiography, conventional tomography, and computed tomography in four patients with steroid induced Cushing's syndrome or simple obesity. Computed tomography was the only modality that definitively diagnosed mediastinal lipomatosis in each case.
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