Age / Sex : 64 / M

Chief complaint: Neck mass for 7 years

1) What is your impression?

Two weeks later, you can see the final diagnosis with a brief discussion of this case.

(답안은 한 개만 보내주시기 바랍니다)

Courtesy: 서경진(Kyung Jin Suh), 동국대학교 경주 병원 (Dongkuk University Kyungju Hospital)

Madelung disease

Discussion

Findings:

l  CT images show extensive fatty mass at both anterior neck, thoracic inlet and upper back. There is no enhancing lesion in fatty mass on enhanced study.

l  MR images show bilateral symmetric mature fatty masses at bilateral anterior neck, supraclavicular area, upper trunk and upper chest wall.

Differential Diagnosis:

1) Madelung disease, also known as benign symmetric lipomatosis, multiple symmetric lipomatosis, and Launois-Bensaude syndrome

2) generalized lipomatosis in association with other conditions, such as Bannayan-Zonana syndrome, Cowden syndrome, Proteus syndrome, and Dercum disease (adiposis dolorosa)

3) drug-induced lipomatosis (from steroidal or antiretroviral agent use

4) multiple familial lipomatosis

Diagnosis: Madelung disease

Discussion:

The clues to Madelung disease came from a review of this patient's clinical history, may his alcohol consumption, and the imaging findings of symmetric mature fat distribution throughout the neck and upper extremities. Biopsy of these lesions enabled us to confirm that they were benign subcutaneous fat.

References:

Mark S. Landis, Roya Etemad-Rezai, Karan Shetty, Mark Goldszmidt. Madelung disease. Radiology 2009; 250:((3):951-954.

Special thanks to Professor Lee In Sook for providing the case.