Endobronchial pulmonary lipomas are rare, and intraparenchymal endobronchial lipomas are even more so. We report the case of a 62-year-old housewife, never-smoker, with a history of vaginitis, psoriasis, hypertension and hysterectomy. During a private health check-up, a chest X-ray revealed a radiopaque mass, 4cm×3cm, with defined borders in the right lung base. She was referred to the Instituto Oncológico Nacional Dr. Juan Tanca Marengo, in Guayaquil, Ecuador. Lung auscultation revealed reduced breath sounds in the right lung base. Other physical examination parameters were normal. Hematology, biochemistry, tumor marker (CEA, CYFRA 21-1, NSE) and lung function test results were within normal values. Chest computed tomography (CT) showed a formation of soft tissues with attenuation coefficient for fat and irregular outline in the right posterior basal segment, containing a 4cm×3cm macrocalcification. The patient underwent right thoracotomy, revealing a tumor in the right posterior basal section of the lung. Right lower lobectomy was performed, with no post-surgical complications. Pathology study of the sample reported intraparenchymal lipoma.

Pulmonary lipomas are thought to represent 0.1%–0.5% of all lung tumors. They occur within the bronchus and very occasionally in the lung periphery.1 According to Watts, Clagget and MacDonald, lipomas in the lung parenchyma or below the pleura may develop from the fat that is often found in the smaller bronchi.2

Few cases of peripheral intrapulmonary lipomas have been published, and the limited literature makes it difficult to diagnose these cases and provide appropriate treatment. Most cases recorded involve chance discovery and diagnosis after surgical resection. The first case reported in the literature, to the best of our knowledge, was a description of an autopsy finding by Buchmam in 1911.2 In 1989, Hirata declared that the treatment of peripheral lipoma was limited to surgical intervention,3 while in 2004, Wood et al.3 found that surgical intervention for diagnostic purposes could be avoided by careful review of the radiological records. These same authors also pointed out that the differential diagnosis of a fatty peripheral pulmonary mass must include not only lipoma, but also fibrolipoma-hamartoma and liposarcoma.3

Our case was a patient with no previous radiological records and a radiopaque intrapulmonary mass, so the only reliable approach for reaching an accurate diagnosis and confirming or ruling out malignancy was pathological analysis (Fig. 1).

Fig. 1.

Chest computed tomography showing soft tissue mass with attenuation coefficient for fat and irregular outline, containing a macrocalcification measuring 4cm×3cm.

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