Inguinal canal lipoma

Last revised by Grace Carpenter on 11 Feb 2023

Inguinal canal lipomas, also known as spermatic cord or round ligament lipomas, are a relatively common but often under-recognized finding on imaging.

Lipomas are usually asymptomatic but can sometimes cause pain and discomfort. They can present as a mass. 

They have no communication with the peritoneal fat. They are not considered as true tumors of fat but as extrusions of extraperitoneal fat extending into the inguinal canal. 

It is seen as a well defined, solid hyperechoic mass, expanding the inguinal canal, which gently effaces the spermatic cord.

The lesion shows attenuation corresponding to fat (-20 to -70 HU). No associated soft tissue component or enhancement.

Oval shaped mass with typical fat signal characteristics:

  • T1: high signal

  • T2: high signal

  • fat-suppressed sequences: shows fat suppression

They are a benign entity and no treatment is usually required in incidental asymptomatic cases. Resection can be offered to patients who are clinically symptomatic.

On imaging, possible differential considerations include:

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