Lipomas Clinical Presentation

Updated: Jun 08, 2017
  • Author: Todd A Nickloes, DO, FACOS; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Presentation

History and Physical Examination

Lipomas are most often asymptomatic. When they arise from fatty tissue between the skin and deep fascia, typical features include a soft, fluctuant feel; lobulation; and free mobility of overlying skin. A characteristic "slippage sign" may be elicited by gently sliding the fingers off the edge of the tumor. The tumor will be felt to slip out from under, as opposed to a sebaceous cyst or an abscess that is tethered by surrounding induration. The overlying skin is typically normal.

Symptoms in other sites depend on the location and can include the following:

  • Lipomas in the major airways can cause respiratory distress related to bronchial obstruction; patients may present with either endobronchial or parenchymal lesions
  • Previously undiagnosed lipomas of the oropharynx may also lead to airway difficulty at the time of intubation
  • Patients with esophageal lipomas can present with obstruction, dysphagia, regurgitation, vomiting, and reflux; esophageal lipomas can be associated with aspiration and consecutive respiratory infections
  • Cardiac lipomas are located mainly subendocardially, are rarely found intramurally, and are normally unencapsulated; they appear as a yellow mass projecting into the cardiac chamber
  • Intramediastinal lipomas may impinge on the superior vena cava, thereby leading to superior vena cava syndrome
  • Intestinal lipomas may manifest as classic obstruction, intussusception, volvulization, or hemorrhage
  • Lipomas arising from fat in the intramuscular septa cause a diffuse, palpable swelling, which is more prominent when the related muscle is contracted
  • Lipomas in intra-articular joint spaces or intraosseous sites, such as the calcaneus, may lead to joint dysfunction and pain that preclude normal ambulation
  • Lipomas may also arise in the dural or medullary components of the spinal cord, thereby leading to cord compression and attendant sequelae [7]
  • Lipomas occur frequently in the breast but not as frequently as expected considering the extent of fat that is present
  • Lipomas may arise from the subcutaneous tissues of the vulva; they usually become pedunculated and dependent
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Complications

Subcutaneous lipomas are primarily cosmetic issues. Lipomas in other locations may cause luminal obstruction or hemorrhage. The images below show a duodenal lipoma that caused gastrointestinal hemorrhage and required removal.

Upper gastrointestinal series shows duodenal lipom Upper gastrointestinal series shows duodenal lipoma with central ulceration where the overlying mucosa has thinned, ulcerated, and bled.
Duodenal lipoma resected through a duodenotomy. Ov Duodenal lipoma resected through a duodenotomy. Overlying mucosa with central ulceration removed and lobulated fatty tumor shelled out intact with capsule. The mucosa was then sutured closed, and the duodenotomy closed. The stitch was placed to orient the specimen for pathologic examination.
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