Pelvic Lipomatosis: The Nuclear Magnetic Resonance Appearance and Associated Vesicoureteral Reflux

Abstract

We report a case of pelvic lipomatosis with ureteral obstruction and vesicoureteral reflux. In addition to computerized tomography, nuclear magnetic resonance imaging provided definite and graphic proof of the diagnosis. Operative treatment consisted of ureteroileocystostomy.

Pelvic Lipomatosis in a Female: Diagnosis and Initial Therapy

“…Diagnosis will be confirmed by CT and NMR. Cystoscopy often shows changes like cystitis cystica, cystitis glandularis or chron ic infections [4], As ureteral obstructions occur preferentially in youn ger patients, their urinary diversion is necessary in many cases [1,4,9]. In our patient there was no obstruction yet, but close controls, at 6-month intervals, of the upper urinary tract have to be done in the next years.…”

“…Because of the extremely reduced capacity of the bladder, hyster ectomy and bladder extension seemed to be the possibil ity to defer permanent urinary diversion. Successful sur gical excision of the fat has been reported in only 1 case [1]. Other concepts of treatment like diet, radiation or steroids have not been very successful [9], So far, there is no means to stop the progression of the disease.…”

“…Before the establishment of computerized tomography (CT), open surgery was mandatory for the precise diagnosis of the disease. Due to CT [5,13] and recently to nuclear magnetic resonance (NMR) imaging [1], pelvic lipomatosis can easily be identified. Pelvic lipomatosis is a rare disease; 111 cases have been re ported in the literature [9] with only 4 reports in white females [2,7,8,11].…”

Pelvic Lipomatosis: A Rare Case with a Good Surgical Outcome

“…Renal failure occurs in 6% of all reported cases. An MRI can also be used for diagnosis, as it permits the characterization of fat planes, and it provides the delineation of an elevated bladder base and the elongation of a posterior urethra [18]. A life threatening complication of pelvic lipomatosis is thromboembolism expressed by either deep venous thrombosis or pulmonary embolism (7%).…”

Welche Therapie bei Lipomatosis pelvis?

“…Rückenschmerzen (10), oberflächliche Thrombophlebitiden (4), rezidivierende tiefe Bein-und Alternativ zum CT kann das NMR eingesetzt werden, das den Vorteil der fehlenden Strahlenbelastung bietet. Es erlaubt im Einzelfall eine genauere Organabgrenzung (1,5,9). Im hier dargestellten Fall war das NMR wegen der exakten Abbildung der gemischt lipomatös-fibrösen Strukturen diagnostisch hilfreich.…”