Background: Lipomas are the most common occurring soft tissue tumors, accounting for approximately half of all soft tissue masses. However, intravascular lipomas (IVLs) are rare. IVLs have been described in case reports in the superior vena cava (SVC), inferior vena cava (IVC), right innominate, common femoral, subclavian, iliac, and renal veins. They are often asymptomatic and found incidentally. No cases have been published detailing a case of an IVL in the left innominate vein (IV) and extravascular extension.
Methods: We present a case of a 61-year-old man who was incidentally found to have a left innominate vein intravascular lipoma extending into the left internal jugular vein (IJV). We present his clinical exam, radiological findings, and surgical treatment.
Results: A 61 year old man presented with chest pain and underwent a CT scan that showed a hypodense mass with fat attenuation in the left IV extending into the left IJV measuring 2.3 x 2 x 5.2 cm. On further evaluation, the patient endorsed some left-hand weakness and increased prominence of veins in the left arm. A multidisciplinary approach with thoracic and vascular surgery performed a successful surgical excision and reconstruction of his innominate vein with reimplantation of his left internal jugular vein through median sternotomy and left neck incision. Post operative course was unremarkable and the patient continues to do well.
Conclusion: The clinical presentation of an intravascular lipoma in a large caliber vessel can be subtle and nonspecific. While a majority are asymptomatic, surgical excision continues to be the mainstay of treatment seen in the literature.