Abstract
Intravascular lipomas are rare benign tumors composed of adipose tissue that originate
from the walls of blood vessels. They most commonly arise from veins, are typically
asymptomatic, and rarely occur in the lower extremities. When large, these tumors
can cause symptoms related to venous obstruction, such as swelling and pain. We report
a case of a 75-year-old man with an intravascular lipoma in the right common femoral
vein, identified during evaluation of lower extremity swelling and poorly healing
ulcers. Surgical resection was ultimately required. This case contributes to the few
published reports of pathologically proven symptomatic intravascular lipomas involving
the lower extremity veins. Comprehensive preoperative imaging played a critical role
in characterizing the lesion. The case facilitates a discussion of key differential
diagnoses, such as atypical lipomatous tumors/well-differentiated liposarcoma and
leiomyosarcoma.
Key Points
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Intravascular lipomas are rare and generally asymptomatic masses that most often arise
in the veins of the upper extremity and thorax.
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The differential diagnosis for a fatty intravascular mass includes benign lipoma,
atypical lipomatous tumor (ALT)/well-differentiated liposarcoma, and leiomyosarcoma.
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Benign lipomas usually demonstrate homogeneous fat signal with thin fibrous septa
and minimal nonadipose components.
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Imaging features suggestive of ALT/well-differentiated liposarcoma are reduced and/or
heterogeneous fat composition, thickened septa, and nodular nonadipose tissue.
Keywords
intravascular lipoma - lipoma - atypical lipomatous tumor - magnetic resonance imaging
- computed tomography
