Pelvic lipomatosis or pelvic fibrolipomatosis represents excessive deposition of fat in the pelvis due to overgrowth of adipose cells leading to compression of pelvic organs.
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Epidemiology
The condition usually presents in patients 20-50 years of age. The condition is predominantly (~66% of cases) seen in African-Americans.
Clinical presentation
Patients usually present with dysuria, haematuria, urgency, urinary incontinence, and/or constipation due to compression of the genitourinary system, vascular system, and lower gastrointestinal tract.
Radiographic features
Plain radiograph
Findings are non-specific and non-diagnostic with areas of lucency around the bladder.
IVP
Inverted pear-shaped or teardrop bladder with dilated ureters.
CT
CT findings are diagnostic with areas of symmetric fat density in the pelvic region. An inverted pear-shaped bladder can be seen. The sigmoid colon may be stretched and surrounded by excess pelvic fat. It also can extend into the abdomen with peripheral displacement of bowel loops.
MRI
Similar to CT findings with hyperintensity noted on T1W imaging in areas containing fat and iso to hyperintensity noted on T2W imaging.
Differential diagnosis
The differential is mainly that of inflammatory conditions resulting in fatty infiltration or other fatty masses.
- proctitis
- differentiated by a history of radiotherapy to the pelvis for proctitis
- ulcerative colitis
- lipoma or liposarcoma
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