Synchronous bilateral lipoma arborescens of bicipitoradial bursa—a rare entity

Abstract

Lipoma arborescens is a rare non-neoplastic condition that affects the synovial lining of joints and bursae accounting for less than 1% of all lipomatous lesions. Characterized by villous proliferation of the synovium, it is an uncommon cause of intra/periarticular mass presenting as a painless, slowly progressive longstanding swelling, and is sometimes accompanied by intermittent monoarticular effusions. We describe a rare case of bilateral lipoma arborescens in the bicipitoradial bursae in a young male referred for MRI evaluation of spontaneous bilateral elbow swelling. We chose to bring this case to light because of the rare simultaneous involvement of the bicipitoradial bursae bilaterally and the role of MR in providing a definite diagnosis, hence obviating the need for biopsy and avoiding consideration of other complex intra/periarticular masses.

Imaging features of lipoma arborescens

“…All patients (n ¼ 15) demonstrated joint or bursa effusion (Figs. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]. Nine patients with 12 lesions revealed villous or frond-like lesions with a narrow base (Figs.…”

“…Based on these characteristic manifestations on CT and MRI, especially MRI, a definite diagnosis of lipoma arborescens can be made (18). MRI with fat saturation sequences has a high specificity and can draw relatively accurate conclusions, thus avoiding unnecessary biopsy (1,16,18). The previous studies (19,20) found that the lesions were arborescent, frond-like synovial masses.…”

“…Lipoma arborescens is an infrequent non-neoplastic lesion that tends to occur in the synovium lining of joints or bursae, occurring in < 1% of all lipomatous conditions, also called lipomatosis arboresces (1). It is characterized by the villous proliferation of the synovium and diffuse hyperplasia of fatty tissue in the subsynovial layer, almost always with a periarticular lesion.…”

Femoral osteochondroma responsible for ischiofemoral impingement, bursitis, and secondary lipoma arborescens mimicking malignant transformation

“…It is characterized by fatty infiltration of the subsynovial connective tissue. It is usually described in the knee (32,33) but may be observed in the hip (34), shoulder (35), wrist (36), or elbow (37). The disease is monoarticular in most cases but involvement of several joints in the same patient has been described (36,38,39).…”

“…The disease is monoarticular in most cases but involvement of several joints in the same patient has been described (36,38,39). Extra-/peri-articular location of LA, especially in bursae, such as in the sub acromial space or prepatellar bursa, has been more exceptionally reported (8,9,36,37,40). In some cases, LA may be associated with osteochondral loose bodies (41).…”