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CHEST RADIOLOGY Table of Contents   
Year : 2007  |  Volume : 17  |  Issue : 4  |  Page : 267-268
Case report: Lung lipoma


Department of Radiodiagnosis, Grant Medical Foundation, Ruby Hall Clinic, Pune, India

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Keywords: Lung lipoma..

How to cite this article:
Atre A, Rajapure S, Joseph J. Case report: Lung lipoma. Indian J Radiol Imaging 2007;17:267-8

How to cite this URL:
Atre A, Rajapure S, Joseph J. Case report: Lung lipoma. Indian J Radiol Imaging [serial online] 2007 [cited 2020 Jun 4];17:267-8. Available from: http://www.ijri.org/text.asp?2007/17/4/267/36874

   Case Report Top


A 66-year-old man suffering from an inguinal hernia had a routine, preoperative chest x-ray examination, which showed a well-defined, rounded pulmonary lesion in the left upper lobe, measuring approximately 6.0 cm in diameter [Figure - 1].

He had no symptoms. There was no relevant past medical history and clinical examination showed no abnormalities in the chest.

He underwent a CT scan of the chest, which demonstrated a well-defined, rounded, left upper lobe lesion, measuring 6.6 6.7 cm in the maximum transverse dimension [Figure - 2]. The lesion had smooth outlines and was in close relation to the left apical segmental bronchus, minimally displacing it. It showed CT attenuation values of −100 to -110 HU, indicating the presence of fat [Figure - 3]. No other solid component, calcification, or any features of malignancy were seen in this lesion. Linear enhancing structures, representing either septae or vessels, were seen traversing it. There was no additional enhancement [Figure - 4].


   Discussion Top


The presence of fat within the lesion is highly suggestive of a lipoma. Although lipomas are the commonest benign neoplasms of the soft tissues, their occurrence in the viscera, including the lungs, [1] is rare. In a review of 3,502 pulmonary tumors, 65 were benign and only 3 were lipomas. [1] In another review of 32 rare pulmonary tumors, Sekine et al. found 12 benign tumors, only 3 of which were lipomas. [2]

Intrapulmonary lipomas are divided into endobronchial and peripheral parenchymal lipomas. Endobronchial lipomas are more common, accounting for 80% of the cases, [3] and arise centrally from fatty tissue in the walls of the proximal lobar or segmental bronchi. The fatty tissue decreases with progressive bronchial branching and disappears when the bronchus is less than 1 mm in diameter, [1],[4],[5],[6],[7] which accounts for the rarity of peripheral lipomas. Over a 90-year period, as few as 8 cases of peripheral intrapulmonary lipomas have featured in the medical literature. [3],[7],[8],[9],[10],[11],[12] The first case was reported in 1911 [8] and the most recent one in 2004. [13]

Peripheral lipomas are more frequent in men, with a peak incidence in the 5 th and 6 th decades and a predilection for the right side and the upper lobe of the lung. [3],[7] The size varies from 1-7 cm. Parenchymal lipomas are asymptomatic because they are peripheral and are only found incidentally on routine radiographs. Endobronchial lipomas, on the other hand, may cause pulmonary changes due to atelectasis and secondary suppuration. [3] Imaging criteria for differentiation between endobronchial and parenchymal lipomas include their location as well as the presence of secondary obstructive changes in cases of endobronchial lipomas.

Benign, peripheral intrapulmonary lipomas usually present as solitary opacities on chest radiographs, indistinguishable on plain films from malignant neoplasms. CT scan is, however, diagnostic and shows a well-defined, homogenous lesion containing fat. This is confirmatory and no further diagnostic evaluation is required.

The previous seven reported patients underwent thoracotomy to establish the diagnosis, as malignancy could not be confidently excluded. In one patient, CT scan was diagnostic and a review of the previous images demonstrated a lesion that had persisted unchanged for 12 years, making malignancy unlikely. In our case, the patient was asymptomatic. The tumor was an incidental finding and showed CT attenuation values of -100 to -110 HU, indicating the presence of fat, with no features of malignancy. As a result, no intervention was performed.

The differential diagnosis of fat-containing peripheral lung masses includes fibrolipomatous hamartoma [14] and liposarcoma. [15],[16] These tumors, however, contain other soft tissue elements and calcium, in addition to fat. [17]

 
   References Top

1.Politis J, Funahashi A, Gehlsen JA, DeCock D, Stengel BF, Choi H. Intrathoracic lipomas: Report of three cases and review of the literature with emphasis on endobronchial lipoma. J Thorac Cardiovasc Surg 1979;77:550-6.  Back to cited text no. 1  [PUBMED]  
2.Sekine I, Kodama T, Yokose T, Nishiwaki Y, Suzuki K, Goto K, et al . Rare pulmonary tumors: A review of 32 cases. Oncology 1998;55:431-4.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Plachta A, Hershey H. Lipoma of the lung: Review of the literature and report of a case. Am Rev Respir Dis 1962;86:912-6.  Back to cited text no. 3  [PUBMED]  
4.Watts AF, Clagett OT, MacDonald JR. Lipoma of the bronchus: Discussion of benign neoplasm and report of a case of enodbronchial lipoma. Thorac Surg 1946;15:132-44.  Back to cited text no. 4    
5.Satub EW, Barker WL, Langston HT. Intrathoracic fatty tumors. Dis Chest 1965;47:308-13.  Back to cited text no. 5    
6.Bango A, Coulbi L, Molinos L, Fernandez R, Justo E, Martinez J. Endobronchial lipomas. Respiration 1993;60:297-301.  Back to cited text no. 6    
7.Hirata T, Reshad K, Itoi K, Muro K, Akiyama J. Lipomas of the peripheral lung: A case report and review of the literature. Thorac Cardiovasc Surg 1989;37:385-7.  Back to cited text no. 7  [PUBMED]  
8.Buchmann E. Zur Lehre der fotalen Lungenatelektase und der fotalen Bronchiektase. Frankfurt Zschr F Path 1911;8:263-303.  Back to cited text no. 8    
9.Touroff AS, Seley GP. Lipoma of the bronchus and the lung. Ann Surg 1951;134:244-50.  Back to cited text no. 9  [PUBMED]  [FULLTEXT]
10.Shapiro R, Carter MG. Peripheral lipoma of the lung: Report of a case. Am Rev Tuberc 1954;89:1042-4.  Back to cited text no. 10  [PUBMED]  
11.Jones L, Lucey JJ, Taylor AB. Intrapulmonary lipoma associated with multiple pulmonary hamartomas. Br J Surg 1973;60:75-8.  Back to cited text no. 11    
12.Zafirakopoulos P, Zorbas J, Creatsas G, Tosios J. Intrabronchial lipoma. Int Surg 1977;62:399-400.  Back to cited text no. 12  [PUBMED]  
13.Wood J, Henderson RG. Peripheral intrapulmonary lipoma: A rare lung neoplasm. Br J Radiol 2004;77:60-2.  Back to cited text no. 13  [PUBMED]  [FULLTEXT]
14.Taniyama K, Sasaki N, Ymaguchi K, Motohiro K, Tahara E. Fibrolipomatous hamartoma of the lung: A case report and review of the literature. Jpn J Clin Oncol 1995;25:159-63.  Back to cited text no. 14    
15.Sawamura K, Hashimoto T, Nanjo S, Nakamura K, Lioka S, Mori T, et al . Primary liposarcoma of the lung: Report of a case. J Surg Oncol 1982;19:243-6.  Back to cited text no. 15    
16.Krygier G, Amado A, Salisbury S, Fernandez I, Maedo N, Vazquez T. Primary lung liposarcoma. Lung Cancer 1997;17:271-5.  Back to cited text no. 16  [PUBMED]  [FULLTEXT]
17.Vassallo M, Rana Z, Allen S. A large transmural thoracic lipoma easily mistaken for pulmonary malignancy. Br J Clin Pract 1996;50:285-6.  Back to cited text no. 17  [PUBMED]  

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Correspondence Address:
Swati Rajapure
Department of Radiodiagnosis, Grant Medical Foundation, Ruby Hall Clinic, 40, Sassoon Road, Pune - 411 001
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-3026.36874

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    Figures

  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]

This article has been cited by
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[Pubmed] | [DOI]



 

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