Lipoma, case 2

Clincal history
At the age of seventeen, this patient underwent resection of a large subcutaneous lipoma in the thoracolumbar region. This athletic woman enjoys jogging regularly although she complained of leg weakness, predominantly on the right side, for ten years duration.
Recently, at age 35, she experienced progressive loss of strength in both legs with new sensory impairment.
Neurological examination shows a pyramidal syndrome, with a probable lesion of the posterior columns and impairment of pain and temperature sensation. Clinically, a T9 compression fracture is suspected.

First MRI (1990)
Image 1: Sagittal T1WI. Multiple lipomas are identified. At C7-T1, note the anterior displacement of the spinal cord. A large hourglass lipoma is seen with a smaller cephalad component at the level of T6-T7 communicating with a larger caudal component, extending from T9 to T11. An additional lipomatous lesion is seen at T12-L1 communicating with the more cephalad lesion.
Image 2: Thoraco-lumbar sagittal T1WI. This additional sagittal cut better demonstrates the lipoma at the T12-L1 level. An additional smaller lipoma is found at the L2 level (see -->).
Image 4: Axial T1WI images at the level of T9-T10 demonstrate mass effect, and anterior and leftward displacement of the cord.
The lipoma is hyperintense on T1WI, and is mostly extramedullary, but does partially infiltrate the spinal cord.

Follow-up MRI (1992 and 1993)
Images 5 - 11: Sagittal and axial T1WI. Note that the surgical procedures attempted to enlarge the spinal canal and decompress the spinal cord. The various lipomas grow slowly with time and are responsible for progressive neurological deterioration (mainly posterior column impairment).

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