Pelvic lipomatosis or pelvic fibrolipomatosis represents excessive deposition of fat in pelvis due to overgrowth of adipose cells leading to compression of pelvic organs.
The condition usually presents in patients 20-50 years of age. The condition is predominantly (~66% of cases) seen in African-Americans.
Patients usually present with dysuria, hematuria, urgency, urinary incontinence, and/or constipation due to compression of the genitourinary system, vascular system, and lower gastrointestinal tract.
Findings are non-specific and non-diagnostic with areas of lucency around the bladder.
Pear shaped or inverted teardrop bladder with dilated ureter.
CT findings are diagnostic with areas of symmetric fat density in the pelvic region. Pear-shaped bladder can be seen. The sigmoid may be stretched and surrounded by excess pelvic fat. It also can extend to the abdomen with peripheral displacement of bowel loops.
Similar to CT findings with hyperintensity noted on T1 in areas containing fat and iso to hyperintensity noted on T2W imaging.
The differential is mainly that of inflammatory conditions resulting in fatty infiltration or other fatty masses.