Multiple symmetric lipomatosis: a diagnostic dilemma

Abstract

Introduction. Multiple symmetric lipomatosis, or Madelung's disease, is a rare condition which is characterized with large symmetrical accumulation of noncapsulated fat tissue in upper arms, neck, and shoulder areas. The disease etiology is unknown, with the highest incidence in the Mediterranean region. Case Presentation. Here, we present the case of Madelung's disease with symmetric fat distribution throughout the neck and history of alcoholism. The patient was treated from several diseases associated with alcoholism and hospitalized several times, but the diagnosis of Madelung's disease was omitted. The thyroid gland disease was excluded, while enlargement of the neck adipose tissue was attributed to obesity. Conclusions. This study points out possible diagnostic mistakes when a physician is not aware of a differentiation diagnosis of symmetrically enlarged neck masses, especially in geographic regions with high incidence of this disease.

Figure 1

Picture of the patient showing Madelung's disease with symmetric accumulation of lipomatous tissue in the cervical region. The most prominent enlargement was found in the retroauricular, occipital, and upper back areas ((a)–(c)). A cervicothoracic magnetic resonance imaging of the neck showing bilateral subcutaneous masses of nonencapsulated adipose tissue in ventral and lateral regions of the neck ((d)–(f)).