Synchronous bilateral lipoma arborescens of the bicipitoradial bursa

dc.creatorCarpenter, Braydenen_US
dc.creatorStokes, Cameronen_US
dc.creatorAnderson, Coleen_US
dc.creatorSederberg, Marken_US
dc.description.abstractBackground: Lipoma arborescens (LA) is a rare intra-articular lesion formed by subsynovial villous proliferation in which subsynovial tissue is replaced by mature adipose cells. It is most commonly reported to appear in the knee joint but has also been seen to involve the shoulder, elbow, hip, ankle, and wrist joints. This report adds to the current understanding of lipoma arborescens by providing a rare presentation, and, to our knowledge, the second case reported in literature of bilateral synchronous lipoma arborescens of the elbow joints. Case report: We present a case of bilateral lipoma arborescens in a 36-year-old male with a history of untreated psoriatic arthritis who presented to an outpatient musculoskeletal clinic with a 6-month history of bilateral elbow pain and mass with the left being worse than the right and no history of trauma or injury. He reported morning exacerbation and accompanying stiffness, locking, and noticeable grinding and clicking in the left elbow. Physical examination revealed limited range of motion in flexion in the left elbow, a palpable mobile mass over the area of the distal biceps tendon bilaterally, and tenderness with resisted pronation and elbow flexion in the left elbow. Radiographs of both elbows showed no structural abnormalities, while a diagnostic ultrasound of the elbows revealed cystic anechoic structures adjacent to the biceps tendon with increased vascularity seen on color doppler and several frond-like appendages that entered into the cystic structure. MRI was obtained which showed severe bicipitoradial bursitis with synovitis, frondlike fat projection suggestive of lipoma arborescens within the bursa, mild insertional biceps tendinopathy, and reactive edema in the proximal radius centered at the radial tuberosity. Surgical intervention was recommended. The patient had the left-sided mass resected by a hand orthopedic surgeon. The patient was doing well at his 4-week follow-up and had no pain with range of motion. The pathology report showed a 4.2x1.8x1.8 cm pink-white pigmented soft tissue fragment with mature adipose tissue with marked chronic inflammation and fibrinous exudate which further confirmed the diagnosis of lipoma arborescens. His contralateral mass will be resected if it becomes symptomatic. Conclusion: Lipoma arborescens is a rare, slowly progressive benign lesion that should be on the differential diagnosis of those with a periarticular mass and a chronic inflammatory condition. In this patient, given his untreated psoriatic arthritis, chronic inflammation is likely responsible for its development. Though harmless, it may be resected if it becomes symptomatic due to the mass effect on surrounding tissues.en_US
dc.titleSynchronous bilateral lipoma arborescens of the bicipitoradial bursaen_US