Dysphagia Caused by Giant Esophageal Fibrolipoma: Imaging Findings

A 44-year-old woman presented to our hospital with progressive dysphagia and weight loss of 1 year. CT scan showed a large mass consisting of fatty tissue anterior to the thoracic vertebra. The differential diagnosis involved esophageal lipoma, tumor, and paraesophageal herniation. Axial CT images are not appropriate for precise detection of the continuity. However, coronal or sagittal plane MR images are reliable for this purpose. Thus, multiple plane imaging is very important and necessary for correct diagnosis. The mass was diagnosed as giant fibrolipoma of the esophagus Keyword: Dysphagia; esophagus; lipoma; magnetic resonance. Özet Kýrk dört yaþýnda kadýn olgu ilerleyici disfaji ve son 1 yýldýr kilo kaybý þikayetleri ile kliniðimize baþvurdu. Bilgisayarlý tomografi (BT) incelemede torasik vertebra ön komþuluðunda yað içeren kitle tespit edildi. Ayýrýcý tanýda özefagial lipom, tümör ve paraözefagial herni düþünüldü. Axial BT kesitleri kitle devamlýlýðýný göstermede yeterli olmayýp koronal ve sagital plan (multiplanar) manyetik görüntüleme sekanslarýnýn önemi ve doðru tanýda gerekliliði görüldü. Kitle dev özefagial fibrolipom tanýsý aldý. Anahtar kelimeler: Disfaji; Lipom; Manyetik Rezonans; Özefagus. OLGU SUNUMU(Case Reports) Submitted : October 23, 2007 Revised : November 25, 2007 Accepted : August 14, 2008 Disfajiye Neden Olan Dev Özefagial Fibrolipom: Görüntüleme Bulgularý Dysphagia Caused by Giant Esophageal Fibrolipoma: Imaging Findings Corresponding Author: Uz Dr. Selim Doganay Department of Radiology Erciyes University, Medical Faculty Kayseri Turkey Telephone : +90 352 437 49 37 E-mail : [email protected] Selim Doganay Specialist, M.D. Department of Radiology Erciyes University, Medical Faculty [email protected] Mecit Kantarcý Assoc. Prof., M.D. Department of Radiology Atatürk University Medical Faculty [email protected] This study was presented at XXIIXth National Radiology Congress, 27-31 October 2007, Antalya, Turkey. 349 Erciyes Týp Dergisi (Erciyes Medical Journal) 2009;31(4):349-353 Introduction Lipoma of the alimentary tract is uncommon, with an overall incidence of 4.1%, but that of the esophagus is extremely rare with an incidence of only 0.4% (1). They originate from undifferentiated mesenchymal cells in the submucosal layer (2). Esophageal lipomas may exceed 10 cm in length and can be pedunculated or sessile (1, 3). They seem to have a predilection for the upper third of the esophagus, which is thought to be due to local effects of the propulsive forces of swallowing on the narrow cervical segment (4). Presenting symptoms are a consequence of progressive esophageal luminal obstruction, including dysphagia, chest discomfort, and regurgitation. Sloughing of the superficial mucosa with resultant low-grade gastrointestinal bleeding may occur due to from chronic friction injury as the pedunculated mass slides within the esophageal lumen or ball-valves across the gastroesophageal junction. Preoperative diagnosis can be reliably established on the basis of computed tomography, endoscopic, and endoscopic ultrasonographic findings (5, 6). In this report, we describe the advantages of multiple plane imaging for correct diagnose. Case Report A 44-year-old woman was referred to our hospital because of progressive dysphagia and weight loss persisting for 1 year. Occasionally, she suffered from recognized chest pain and regurgitation. In her physical examination and laboratory tests, no abnormality was detected. Computed tomography (CT) examination showed that a mass in the lower thorax was located anterior the thoracic vertebra, behind the left atrium, in the lower one-third of the esophagus (Pic.1a,b). The mass size was 75x46x33 mm. The CT attenuation of the mass was (-) 112 Hounsfield units, which was consistent with fatty tissue. No enlarged lymph nodes were seen in the neck, mediastinum, or upper abdomen. The mass seemed to extend through the esophageal hiatus to the peritoneal fatty tissue on axial sections of CT. The axial and coronal sections of MR images were used to distinguish esophageal mass from the paraesophageal herniation. The images demonstrated a nonhomogeneous hyperintense mass on T1 (Pic. 2a), T2weighted images and decreased signal intensity on T1-weighted images with fat suppression (Pic. 2b). There was focal fibrous tissue which was hypointense on T2-weighted images. There were no peduncul or vasculary component of the mass. No herniation of the stomach or intestines to the thorax was detected. Although the findings observed on axial sections of CT and MR were similar, coronal sections of T2weighted MR images (Pic. 2c) clearly showed the location of the fatty mass. Postoperative findings confirmed our diagnosis.