Figure 1
Axial CT images after iv administration of iodinated contrast agent.
Clinical History
Abdominal CT examination after left nephrectomy.
Imaging Findings
The abdominal CT examination was performed for oncological follow-up after left nephrectomy. The images, acquired 80 seconds after iv administration of iodinated contrast agent, showed a fusiform mass in the first jejunal loop, 2,5 cm in length and with negative density values in relation with a fatty nature.
The patient never reported any gastro-intestinal symptom.
Discussion
Lipoma are frequent benign tumors and represent 13-15% of all the benign tumors of the small intestine. More than 50% arise in the ileum, they are often solitary and their size varies between 1 and 6 cm. Most small bowel lipomas can be subserosal or intramural but frequently they arise from the submucosa and tend to grow into the lumen.
Some endoluminal lipomas are symptomatic because when they grow and become pedunculated, they may cause intussusception.
Barium contrast studies demonstrate usually a smoothly lined sessile or pedunculated filling defect. The shape of the lesion can be modified under compression or during peristalsis.
If the lesion is causing intussusception a typical “spring coil “ pattern is usually seen.
CT images show a homogeneous mass in close relation to a small bowel loop and with density values between –60 and –120 HU. CT is also particularly useful for visualizing the less frequent extra-enteric, subserosal tumors, which will be more difficult to visualize on barium studies.
Small intestine lipoma does not need any treatment if asymptomatic because there is no risk for a malignant transformation.
Some endoluminal lipomas are symptomatic because when they grow and become pedunculated, they may cause intussusception.
Barium contrast studies demonstrate usually a smoothly lined sessile or pedunculated filling defect. The shape of the lesion can be modified under compression or during peristalsis.
If the lesion is causing intussusception a typical “spring coil “ pattern is usually seen.
CT images show a homogeneous mass in close relation to a small bowel loop and with density values between –60 and –120 HU. CT is also particularly useful for visualizing the less frequent extra-enteric, subserosal tumors, which will be more difficult to visualize on barium studies.
Small intestine lipoma does not need any treatment if asymptomatic because there is no risk for a malignant transformation.
Differential Diagnosis List
Jejunal lipoma
Final Diagnosis
Jejunal lipoma
References
[1]
Cakirer S, Sirvanci M, Duran C.
Jejunojejunal intussusception secondary to lipoma in an adult.
Acta Radiol. 2002 Mar;43(2):196-7. (PMID: 12010304)
[2]
Kakitsubata Y, Kakitsubata S, Nagatomo H, Mitsuo H, Yamada H, Watanabe K.
CT manifestations of lipomas of the small intestine and colon.
Clin Imaging. 1993 Jul-Sep;17(3):179-82. (PMID: 8364788)
[3]
Ellis H.
Tumours of the small intestine.
Semin Surg Oncol. 1987;3(1):12-21. (PMID: 3809852)
[4]
Genchi V, Scialpi M, Scarciolla G, Pepe AS, Federico R.
Duodeno-jejunal giant lipoma. Diagnosis using computerized tomography in a case.
Radiol Med (Torino). 2000 Oct;100(4):287-9. (PMID: 11155459)
Case information
| URL: | https://www.eurorad.org/case/3006 |
| DOI: | 10.1594/EURORAD/CASE.3006 |
| ISSN: | 1563-4086 |
Figure 2
Coronal MPR CT image.
Another view of the jejunal lipoma: coronal reconstruction.
Figure 3
LSagittal MPR CT image.
Sagittal reconstruction shows the position of the lipoma in a jejunal loop.
Coronal MPR CT image.
Another view of the jejunal lipoma: coronal reconstruction.
LSagittal MPR CT image.
Sagittal reconstruction shows the position of the lipoma in a jejunal loop.