The soft tissue mass could be easily separated and excised. A 20 cm long incision was given on the medial side of thigh. The excision of lipoma was done under spinal anesthesia. Preanesthetic check-up was done and patient was assigned American Society of Anesthesiologists (ASA) grade II. Routine hematocrit values, X-ray chest, and electrocardiogram (ECG) were done. The tissue diagnosis was made with FNA from the swelling which showed mature adipose cells and confirmed diagnosis of lipoma. The MRI showed displacement of adjacent muscles and adductor canal containing femoral neurovascular bundle (Figure 2). The magnetic resonance signal showed fat density and confirmed the diagnosis of well-encapsulated intramuscular lipoma, size 30 × 16 × 15 cm.
A thick septum seen showed the extension of anterior compartment (Figure 1). The MRI of thigh revealed a large mass in the medial compartment of thigh between adductor muscles. The ultrasonography of the thigh revealed a large size soft tissue mass probably lipoma. The motor and sensory examination of lower limbs was normal. There was no evidence of deep vein thrombosis in the leg veins. The popliteal and posterior tibial arteries were well palpable.
Compartments of leg radiology skin#
This mass was not attached to skin but was present deep in the medial compartment of thigh. The palpation revealed a nontender, firm mass having smooth surface. The inspection showed a small inconspicuous swelling in middle of left thigh. No changes in skin color or texture were seen. On inspection, there was difference of 5 cm in mid-thigh circumference between left and right thigh. The patient’s presentation to clinician was due to heaviness in leg on walking. Later he felt a swelling in the left thigh. The first thing observed by the patient was disparity in size of thigh. In this case report, we present a usual giant lipoma of thigh in the adductor compartment of left thigh, adductor canal displaced grossly to one side and extending to anterior compartment of thigh.Ī 50-year-old man presented with history of swelling in the left thigh for last three years. These findings could make correct diagnosis in 69% of cases. The findings of stranding, nodularity, and size of tumor can give diagnosis of lipoma or well-differentiated liposarcoma. The intensity of signal can about fat necrosis with in lipoma. Magnetic resonance imaging can diagnose lipoma due to presence of thin septa and can also differentiate from well-differentiated liposarcoma which has thick and irregular septa. Instead of limiting to on adductor compartment, these intermuscular lipomas can invade the nearby compartment and also a muscle with intermuscular component. These giant size lipomas in adductor compartment present a diagnostic challenge as these are deep seated. Uncommonly giant lipoma of adductor compartment of thigh can press neurovascular structures in the adductor canal. Lipomas present as painless swelling but large size lipoma can compress the nearby nerves and can become painful. Rapid increase in size of a long-standing lipoma suggests a sarcomatous change. There is always a confusion with well-differentiated liposarcoma. The giant variant of intramuscular lipoma is rare. A lipoma having length more than 10 cm or weighing more than 1000 g is defined as giant lipoma. Lipomas are very slow growing and may reach a size of 5–10 cm. The intramuscular lipomas are deep seated within the muscles. The subcutaneous or superficial lipomas are more common than deep lipomas occurring in muscular compartments. Subcutaneous lipomas are most common occurring on back, neck, head, and shoulders. Deep lipomas can occur in intermuscular and intramuscular plane. Lipomas can be superficial or deep, the plane of demarcation being deep fascia. Lipomas are usually single but can be multiple in about 5–15% of patients. The only difference between subcutaneous fat and lipoma is that lipoma contains a few thin septa which are less than 2 mm thick. Lipoma is the most common benign tumor of the adipose tissue and can occur anywhere in the body.
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