Macrodystrophia Lipomatosa Involving Both Median and Tibial Nerves: A Two-Case Series

Macrodystrophia lipomatosa (MDL) is a rare congenital disorder marked by excessive proliferation of mesenchymal tissues, predominantly adipose tissue, which often manifests in the upper extremities (particularly the median nerve) and less frequently in the lower extremities (such as the tibial nerve). When MDL affects peripheral nerves, it is commonly associated with fibrolipomatous hamartoma (FLH), a benign fibrofatty overgrowth. The MRI is central to diagnosing MDL, as it provides critical visualization of pathological fat infiltration within the enlarged nerve. We present two cases illustrating the MRI characteristics of MDL in both the median and tibial nerves. Recognizing these hallmark radiological features is essential for accurate diagnosis, differentiation from other neuropathies, and informed management.