Episacral Lipomas

Original Editor - Rewan Aloush

Top Contributors - Rewan Aloush, Kim Jackson and Lucinda hampton  

Introduction

• The most common type of pain in the fatty tissue of the low back is the tender fatty nodule in the SI area, some times called the episa-croiliac lipoma or "Back mouse".Although it has been speculated that some fatty tissue may herniate through the normal deep fascia and become edematous and the source of pain, the significance of these nodules is highly disputed. clinically the patent may complain of pain in the tender nodules, which are palpable and often bilateral. The "mass" is usually palpable as a mobile soft tumor that splis beneath the examining finger. the treatment ranges from ignoring the lesion as insignificant to multiple puncturing and injection of the nodule with local anethetic, followed by massage. surgical removal does not seem justified because of the uncertainty regarding the significance of these lipoma. A less common area of pain is the normal presacral fat pad. The patient is most often female, and the pain may be related to the menstural cycle. There may even be complaints of a sanse of "swelling" in the area, although none is usually present on examination. Most likely, pain in this normal fat pad is referred from elsewhere, but the cause remains obscure.
• Episacral lipoma is a small, tender subcutaneous nodule primarily occurring over the posterior iliac crest. Episacral lipoma is a significant and treatable cause of acute and chronic low back pain. Episacral lipoma occurs as a result of tears in the thoracodorsal fascia and subsequent herniation of a portion of the underlying dorsal fat pad through the tear. This clinical entity is common, and recognition is simple. 

Clinical Picture

A lipoma is abenign tumor made of fat tissue They are generally

1. soft to the touch,
2. movable,
3. painless. 
4. They usually occur just under the skin but occasionally may be deeper.
5. Most are less than 5 cm in size

Risk Factors

1. family history, 
2. obesity
3. lack of exercise

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Causes

</section>It’s not clear for sure what causes them. Middle-aged men and women tend to get them more, and they run in families.

They often appear after an injury, though doctors don’t know whether that’s what makes them form.

Inherited conditions can bring them on. Some people who have a rare condition known as Madelung’s disease can get them. This most often affects alcoholic men of Mediterranean ancestry.<section>

Symptoms

</section>They usually appear as small, soft lumps. They’re usually less than 2 inches wide. Sometimes, more than one will develop.

When you press on one, it may feel doughy. It will move easily with finger pressure. They don’t normally hurt, though they can cause pain if they bump up against nearby nerves or have blood vessels running through them.

Diagnosis

Diagnosis is typically based on a Physical exam. Occasionally medical imaging or tissue biopsy is used to confirm the diagnosis.

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Treatment

</section>Since lipomas aren’t harmful, many times doctor will leave them alone. You may be asked to keep an eye on it between visits.

Small Lipomas

<section></section>If one hurts doctor can take it out surgically with a small cut.

Other possible treatments include:

• Steroids
• Liposuction

Large Lipomas

Lipomas bigger than 2 inches are sometimes called “giant lipomas.” They can cause nerve pain, make you feel self-conscious about your looks, or make it harder for clothes to fit.

It’s a little harder to take out one of these. You most likely would need to be given something that will make you sleep during the procedure. In this case, you’d have to ask someone to drive you home afterward.

Lipomas rarely come back once removed and don’t make it more likely that you’ll get other diseases.