Publish in this journal
Journal Information
Vol. 50. Issue 12.
Pages 562-563 (December 2014)
Vol. 50. Issue 12.
Pages 562-563 (December 2014)
Letter to the Editor
DOI: 10.1016/j.arbr.2014.10.002
Full text access
Extra-Vascular Lipoma of the Subclavian Artery
Lipoma extravascular de la arteria subclavia
Visits
3645
Massine El Hammoumia,b,
Corresponding author
hamoumimassine@hotmail.fr

Corresponding author.
, Mustafa Taberkaneta,b, El Hassane Kabiria,b
a Department of Thoracic Surgery, Mohamed V Military University Hospital, Faculté de Médecine et de Pharmacie, Université Mohamed V, Rabat, Morocco
b Department of Vascular Surgery, Mohamed V Military University Hospital, Rabat, Morocco
This item has received
3645
Visits
Article information
Full Text
Bibliography
Download PDF
Statistics
Figures (1)
Full Text
To the Editor:

Intravascular lipoma is defined as a lipoma arising in the media layer of blood vessels with low adipocyte content; an extravascular or extraluminal lipoma may be formed by invagination of adjacent fatty tissue. Only 9 cases of lipoma in the vascular wall have been described.1

We present the case of a lipoma located in the left subclavian artery. We have found no similar cases in the literature.

A 65-year-old male was admitted due to a mass in the region of the left subclavian artery. Physical examination showed a deep mass, 6mm in size, along the subclavian artery with no neurological or vascular deterioration. Sonography and computed tomography (CT) of the chest (Fig. 1A–C) revealed a well-defined mass that was thought to possibly be an extremely rare subclavian lipoma. There was extensive contact along the subclavian artery but no intravascular mass. The tumor was excised via an incision in subclavian region, after being safely separated from the adjacent subclavian artery and vein and brachial nerve structures (Fig. 1D). The subclavian vein sustained a minimal injury that could be rapidly repaired. The patient's progress was incident-free. Histopathological examination revealed mature adipocytes.

Fig. 1.

(A) Chest CT showing a hypodense mass in the subclavian region (transversal projection). (B) Sagittal chest CT showing slight contact of mass with left subclavian artery. (C) CT reconstruction showing subclavian vein and artery separated by the lipoma. (D) Preoperative image of lipoma with persistent adherence to the subclavian artery. BN: brachial nerve; SCA; subclavian artery; SCV: subclavian vein.

(0.37MB).

Lipomas are very uncommon primary vascular tumors arising in venous walls, particularly in the inferior vena cava, and are found in 0.5% of abdominal CT examinations.2

Extravascular lipomas are very rare, and intravascular lipomas are extraordinarily rare. A hypothesis to explain the formation of these lipomas has been proposed: the tumor may arise in the vascular wall or in the perivascular adipose tissue. When the lipoma arises in the vascular wall, intravascular growth may be seen even when the vascular media layer is underdeveloped and contains few adipose cells.3 This suggests that our patient's tumor arose in the perivascular tissue and subsequently penetrated the artery via mechanical intrusion or invagination rather than by infiltration of the vascular wall.

Most vascular lipomas are asymptomatic and are revealed on incidental CT or magnetic resonance imaging (MRI). Symptomatic tumors may cause thrombosis or venous occlusion.4

Although the presence of a lipoma may be confirmed by sonography, the magnitude and depth of the subclavian lesions cannot be appropriately assessed with this technique. Both CT and MRI are useful for the evaluation of subclavian lipomas. Advocates of MRI believe that it provides reliable confirmation of the adipose character of the mass and a more accurate definition of the magnitude of the lesion and its relationship with surrounding structures. We, however, agree with the CT defenders who claim that most of the clinically relevant information on most lesions can be accessed by CT just as clearly as with MRI, but CT is preferable for reasons of cost, availability and ease in obtaining images.

Differential diagnosis includes angiomyolipoma, poorly encapsulated, containing mature adipocytes and small vessels with heterotopic calcifications, cavernous hemangioma, a vascular mass with small serpiginous vessels and phleboliths, cystic hemangioma, mixed-fibrous tumors and lipomatous hemangiopericytoma.5

Symptomatic lipoma or suspected malignancy are indications for surgical intervention.

Lipomas located in atypical sites are not easy to operate. Careful planning is necessary and the patient must be referred to a cardiothoracic surgeon. Adverse consequences of treatment, such as vascular lesions in a conscious patient or injuries caused by an inexperienced surgeon must be avoided.

Conflict of Interests

The authors have no conflict of interests to declare.

References
[1]
S.R. Ryu, J.Y. Park, Y.S. Ryu, Y.H. Yu, D.J. Yang, B.H. Lee, et al.
Intravascular lipoma of the right subclavian vein.
Tuberc Respir Dis (Seoul), 67 (2009), pp. 154-157
[2]
A. Lomeo, G. D’arrigo, A. Scolaro, M. Mudanò, M.C. Monea, G. Mauceri, et al.
A case of intra and extra-vascular lipoma of the subclavian vein.
EJVES Extra, 13 (2007), pp. 37-39
[3]
M.J. Mcclure, J. Sarrazin, L. Kapusta, J. Murphy, A.M. Arenson, W. Geerts.
Intravascular femoral vein lipoma: an unusual cause of lower limb venous obstruction.
Am J Roentgenol, 176 (2001), pp. 463-464
[4]
S. Vinnicombe, A.G. Wilson, R. Morgan, K. Saunders.
Intravascular lipoma of the superior vena cava: CT features.
J Comput Assist Tomogr, 18 (1994), pp. 824-827
[5]
A. Fuchs, P. Henrot, F. Walter, S. Iochum, J. Vignaud, J. Stines, et al.
Lipomatous tumors of soft tissues in the extremities and the waist in adults.
J Radiol, 83 (2002), pp. 1035-1057

Please cite this article as: El Hammoumi M, Taberkanet M, Kabiri EH. Lipoma extravascular de la arteria subclavia. Arch Bronconeumol. 2014;50:562–563.

Copyright © 2013. SEPAR
Idiomas
Archivos de Bronconeumología (English Edition)

Subscribe to our newsletter

Article options
Tools
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

es en
Política de cookies Cookies policy
Utilizamos cookies propias y de terceros para mejorar nuestros servicios y mostrarle publicidad relacionada con sus preferencias mediante el análisis de sus hábitos de navegación. Si continua navegando, consideramos que acepta su uso. Puede cambiar la configuración u obtener más información aquí. To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here.