Intravascular lipomas, also known as intravenous lipomas, are rare benign primary intravascular lesions with fatty nature 1.
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Clinical presentation
They are usually asymptomatic. When intravascular lipomas become large, they can cause partial obstruction and mass effect. If they occur in superior vena cava, they can cause superior vena cava syndrome or mediastinal compression 5.
Pathology
They appear as circumscribed intravascular masses composed of well-differentiated adipose tissues. They originate from the vein wall and grow into the vascular lumen or spread extraluminally.
The inferior vena cava is the most commonly reported location. Less commonly, it can involve the superior vena cava, brachiocephalic, subclavian, internal jugular, external iliac and common femoral veins.
Radiographic features
They are usually an incidental finding on CT examination. As with any lipoma, they have characteristic fat appearance in different imaging modalities. They are characteristically well-defined, homogeneous masses without any soft tissue component, haemorrhage or breackdown. They are confirmed on MRI as completely suppressed lesions on fat-saturated sequences, high T1 and T2 signal with no post-contrast enhancement.
Treatment and prognosis
Surgery may be considered depending on its size and clinical manifestations, especially if causing vascular obstruction.
Differential diagnosis
The differential diagnosis includes fat-containing intravascular masses, whether benign or malignant like:
- intravascular leiomyoma: benign primary vascular masses of non-fatty nature
- liposarcomas: appear as heterogeneous lesions with post-contrast enhancement
- retroperitoneal leiomyosarcomas: rarely to be completely intravascular
Being intravascular, it is important to be differentiated from intravascular extension of tumours or vascular thrombosis which are much common and critical considerations.
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