Letter to the Editor
The Role of Imaging Methods in the Diagnosis of Pulmonary Lipoma
Papel de las pruebas de imagen en el diagnóstico del lipoma pulmonar
Miriam Menna-Barreto, Gláucia Zanetti, Edson Marchiori
Corresponding author
Servicio de Radiología, Federal University of Río de Janeiro, Río de Janeiro, Brazil
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"resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 695 "Ancho" => 995 "Tamanyo" => 84983 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Axial contrast-enhanced chest computed tomography of a 35-year-old woman with dyspnea, chest pain, and hemoptysis over several months. 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The nodule has fat density (mean density, −41<span class="elsevierStyleHsp" style=""></span>HU) (C).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with great interest the letter to the editor from Bacalja et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> who reported the case of a 58-year-old man presenting with a pulmonary mass in the left upper lobe. Left upper lobectomy was performed, with a final diagnosis of intrapulmonary lipoma. The authors commented on the radiologists’ difficulty in determining the nature of the lesion.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We would like to highlight the role of imaging techniques, particularly computed tomography (CT), as an important tool in the evaluation of patients with intrapulmonary lipomas. We report the case of a 52-year-old asymptomatic man who was referred after a nodule was detected on a routine chest X-ray. Physical examination and laboratory test results were normal. High-resolution CT showed a well-defined round nodule measuring 13<span class="elsevierStyleHsp" style=""></span>mm in diameter in the right lower lobe. The nodule was hypodense, with a mean density of −30 Hounsfield units (HU), compatible with a fat-containing lesion (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). These findings indicated a benign pattern, with CT characteristics consistent with an intrapulmonary lipoma. The patient is currently being monitored in the outpatient clinic, and the nodule remains unchanged after 2 years.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Lipomas are benign mesenchymal tumors composed of adipose tissue. Although they are a common form of soft-tissue tumor, intrapulmonary lipomas are exceptionally rare.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2,3</span></a> Most intrapulmonary lipomas are asymptomatic, with the majority being found incidentally on routine radiographs as solitary opacities, indistinguishable on plain films from malignant neoplasms.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2–4</span></a> On CT, lipomas present as well-defined, round, homogeneous nodules, with fat attenuation CT values (−30 to −150<span class="elsevierStyleHsp" style=""></span>HU).<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2–4</span></a> The presence of intranodular fat is a reliable indicator of a benign pattern, and the diagnosis of pulmonary lipoma depends heavily on the detection of fat within the lesion.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Magnetic resonance imaging (MRI) also enables the distinction of different lesion components, including fat. On T1-weighted sequences, fat appears as areas of high signal intensity. Contrast-enhanced T1-weighted sequences with fat suppression show signal loss of the fat component. These findings are characteristic of the presence of fat.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2,5</span></a> The main entity considered in the differential diagnosis of intrapulmonary nodules with fat is hamartoma. These nodules frequently have focal areas of fat alternating with areas of calcification.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In conclusion, both CT and MRI can help to identify intranodular fat, a reliable indicator of their benign nature that eliminates the need for invasive procedures, such as pulmonary biopsy or surgery. Although rare, intrapulmonary lipomas should be included in the differential diagnosis of homogeneous fat-containing lesions.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Menna-Barreto M, Zanetti G, Marchiori E. Papel de las pruebas de imagen en el diagnóstico del lipoma pulmonar. Arch Bronconeumol. 2016;52:223.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 714 "Ancho" => 1500 "Tamanyo" => 122909 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Axial CT images with lung (A) and mediastinal (B) windows showing a well-defined hypodense nodule measuring 13<span class="elsevierStyleHsp" style=""></span>mm in diameter in the right lower lobe. The nodule has fat density (mean density, −41<span class="elsevierStyleHsp" style=""></span>HU) (C).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intraparenchymal pulmonary lipoma clinically mimicking malignant neoplasm" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Bacalja" 1 => "I. Nikolić" 2 => "L. 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Horio" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Asian CardiovascThorac Ann" "fecha" => "2015" "volumen" => "23" "paginaInicial" => "338" "paginaFinal" => "340" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chemical-shift MRI of pulmonary hamartomas: initial experience using a modified technique to assess nodule fat" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Hochhegger" 1 => "E. Marchiori" 2 => "D.Q. Reis" 3 => "A.S. Soares Jr." 4 => "L.S. Souza" 5 => "T. Brum" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Roentgenol" "fecha" => "2012" "volumen" => "199" "paginaInicial" => "W331" "paginaFinal" => "W334" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005200000004/v2_201604010234/S1579212915002086/v2_201604010234/en/main.assets" "Apartado" => array:4 [ "identificador" => "49861" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005200000004/v2_201604010234/S1579212915002086/v2_201604010234/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915002086?idApp=UINPBA00003Z" ]
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| 2019 February | 47 | 16 | 63 |
| 2019 January | 22 | 9 | 31 |
| 2018 December | 26 | 16 | 42 |
| 2018 November | 44 | 32 | 76 |
| 2018 October | 81 | 31 | 112 |
| 2018 September | 44 | 5 | 49 |
| 2018 May | 24 | 0 | 24 |
| 2018 April | 27 | 3 | 30 |
| 2018 March | 40 | 6 | 46 |
| 2018 February | 22 | 5 | 27 |
| 2018 January | 17 | 4 | 21 |
| 2017 December | 28 | 5 | 33 |
| 2017 November | 26 | 6 | 32 |
| 2017 October | 14 | 8 | 22 |
| 2017 September | 29 | 4 | 33 |
| 2017 August | 22 | 6 | 28 |
| 2017 July | 18 | 3 | 21 |
| 2017 June | 44 | 12 | 56 |
| 2017 May | 29 | 9 | 38 |
| 2017 April | 22 | 10 | 32 |
| 2017 March | 22 | 3 | 25 |
| 2017 February | 18 | 5 | 23 |
| 2017 January | 16 | 13 | 29 |
| 2016 December | 21 | 12 | 33 |
| 2016 November | 35 | 19 | 54 |
| 2016 October | 34 | 23 | 57 |
| 2016 September | 28 | 6 | 34 |
| 2016 August | 46 | 5 | 51 |
| 2016 July | 42 | 8 | 50 |
Show all
