Posterior Neck Lipoma

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Posterior Neck Lipoma

Authors, Editors, Case Information Author: Anthony Noll, DO, MHA Affiliation: University of South Alabama Co Author(s): Bishop Carmichael, DO Senior Editor: Alex Houser, DO Clinical Vignette: A 22-year-old male college baseball player presented for a posterior neck "bump" that was non-painful and slowly increasing in size over the course of one year. Exam revealed a mobile/non-fixed mass, measuring approximately 3.5 x 3.5 cm in size, cephalad to the T1 prominence without any pain to palpation or overlying erythema noted. Type of Probe Used: 12-4 MHz Linear Array Unlabeled Short Axis View of the Lipoma Unlabeled Short Axis View of the Lipoma Labeled Short Axis View of the Lipoma Labeled Short Axis View approximately 0.5-1 cm cephalad from the T1 prominence, shows a subcutaneous/epidermal isogenic thickening that measures approximately 3.5 cm in width by 1.2 cm deep. The borders of this image were enhanced with a solid border to signify the differentiation in the subcutaneous tissues, but no definitive "capsule" is present. Unlabeled Long Axis View of the Lipoma Unlabeled Long Axis View of the Lipoma Labeled Long Axis View of the Lipoma Labeled Long Axis View approximately 1 cm cephalad from the T1 prominence, shows a subcutaneous/epidermal isogenic thickening that measures approximately 3.0 cm in length by 1.2 cm deep. The borders of this image were enhanced with a solid border to signify the differentiation in the subcutaneous tissues, but no definitive "capsule" is present. Interpretation Image Interpretation: Thickened homogenous lesion appreciated in the superficial fatty and other epidermal layers that does not extend into the subcutaneous tissues deeper to this, which correlated to the region of the previously identified mass. These changes appear to be superficial and cephalad to the T1 prominence, with superior aspects of the T1 transverse processes identified (best in short axis), consistent with a lipoma. Teaching Pearl: With this patient presenting for a posterior neck mass in the setting of increased training/conditioning, consisting mostly of back squat/barbell exercises, a lipoma and other micro-trauma based pathologies should be considered for this differential. Not all lipomas have a distinct capsule on imaging, which was noted in this case. Additionally, the presence of this "echogenic" mass in the subcutaneous space with additional features of striation components also points towards lipoma, while the lack of vascularization components in this mass do not support a malignant process present (Kuwano et al, 2009). With the patient in this case reporting no pain with this mass, nor activity limitation/ADL limitation, it would be appropriate to continue with intermittent clinical observations as indicated. Reference: Kuwano Y, Ishizaki K, Watanabe R, Nanko H. Efficacy of diagnostic ultrasonography of lipomas, epidermal cysts, and ganglions. Arch Dermatol. 2009;145(7):761–764.
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Authors, Editors, Case Information

Unlabeled Short Axis View of the Lipoma

Labeled Short Axis View of the Lipoma

Unlabeled Long Axis View of the Lipoma

Labeled Long Axis View of the Lipoma

Interpretation

UPCOMING EVENTS

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