Primary intraarterial occlusive lipoma

Lipomas are the most frequent soft tissue tumors. Intravenous lipomas are very uncommon, but even more unusual are intraarterial lipomas. A 68-year-old heavy smoker man, with chronic alcoholism, retinopathy, dyslipidemia, and a history of type 2 diabetes mellitus of more than 10 years of evolution was hospitalized in a state of dependency. He presented ulcers on both heels and right foot sole extending to the fifth metatarsal base and bedsores in the iliac and sacral regions. Ulcer cultures showed growth of Klebsiella pneumoniae OXA34. A computed tomography angiography scan revealed that the right posterior tibial artery showed several segments with signs of obstruction or sub-occlusive stenosis along its entire length, but especially in the distal two-thirds. The patient underwent supracondylar amputation of the right lower limb. Histopathological sections of the amputated leg showed calcific atherosclerosis obliterans of the posterior tibial artery and complete occlusion in the middle portion of this artery. The occlusion was due to a well-differentiated, white adipose tissue with lipid vacuoles of uniform size. To our knowledge, this case is the first known report of a primary intraarterial lipoma in a peripheral artery. The proliferating adipose tissue within the arterial lumen contributed to distal limb ischemic necrosis. Although an intraarterial lipoma is rare, it should be considered in the differential diagnosis of the causes of peripheral arterial occlusion.