Intramuscular elbow lipoma (MRI)

Case contributed by Dai Roberts
Diagnosis probable

Presentation

Painless elbow mass

Patient Data

Age: 50 years
Gender: Male

Encapsulated simple appearing lipoma which appears within the supinator muscle, surrounding the radial neck and contacting the distal biceps and brachialis tendons. Thin septations but no thick septations, and maximally 4.7 cm in craniocaudal length. The fat saturates uniformly and completely on the fat-saturated sequences with no nonfatty components or edema. No bony destruction. The lipoma displaces the posterior interosseous nerve anteriorly.

Case Discussion

MRI is the investigation of choice for assessing nonsuperficial and deeper masses as it can assess the full extent and relations with other structures. Oil bead markers placed for the MRI help to identify the region of concern.

Fatty masses/lipomas should be assessed for nonfatty components and edema, which suggests the fatty lesion could be an atypical lipomatous lipoma (ALT) or potentially a liposarcoma. The latter will have more aggressive features. Lipoma and ALT can have a significant overlap in imaging features and a change in size or pain in the lesions can be the only discriminator,

The lipoma shown has a 'simple' appearance but it is an atypical position and relatively large in size, therefore, it should be referred to the surgical team

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