Intramuscular infiltrating lipoma of the longus colli muscle. a very rare cause of neck structures compression.

Abstract

medially and on the right side of the prevertebral retropharyngeal space from C2 to C5. The mass showed irregular and lobulated edges only at its inferior pole, with clearly visible margins in the other areas; it presented with an overt adipose intensity ( ● ▶ Fig. 1 ). The mass was responsible for the compression of the esophagus and pharynx, which were dislocated anteriorly and towards the left. The trachea was also displaced enough to be aff ected by a reduction in the air column volume at the level of the epiglottis. Furthermore, the lesion dislocated the vasculoner vous axis of the neck anteriorly and laterally. General endotracheal anesthesia was performed. Intubation was carried out with the assistance of a fi broscope because of the stenotic and displaced course of the upper airways. We planned a right anterior retropharyngeal approach. The skin was incised two centimeters below the angle of the right mandible and the incision continued along the anterior edge of the homolateral sternocleidomastoid muscle for eight centimeters. Once the fascia of the right longus colli muscle was reached, it was incised to access the lesion that bulged among the fi bers of the muscle. The lesion was easily dissected in its superior and deeper portions, but a cleavage plan was less evident at its lower pole. So, after the removal of the great part of the lesion, wide excision of the muscle was performed inferiorly ensuring that no residual tumor was left. The procedure resulted in complete removal of the lesion. Introduction & Lipomas are the most common benign soft tissue mesenchymal tumors. They are usually located in the subcutaneous layer without infi ltrating adjacent tissues [12] . Infi ltrating lipomas, by contrast, are uncommon entities that characteristically infi ltrate skeletal muscles with a propensity for local recurrence if they are incompletely excised [1] . These infi ltrating lesions can be subclassifi ed into intermuscular and intramuscular lipomas [5, 11, 12] . We describe the case of a large intramuscular lipoma of the right longus colli muscle located at the level of C2-C5. Although other reports of retropharyngeal space lipomas exist [7, 13, 18, 20, 24] , ours seems to be the fi rst case of a longus colli intramuscular lipoma described in the English literature since 1988 [7] .