What is Causing This Man’s Swollen Shoulder?

A middle-aged man came to the ambulatory clinic with left side chest discomfort and painless increase in girth of his left shoulder for last decade (Figure 1 and 2). He reported no similar swelling of the other limbs nor was he living in area endemic to filariasis. 

History

He had no similar family history and was a lifetime nonalcoholic. 

Physical Examination

Physical exam revealed asymmetric diffuse enlargement of the left shoulder and arm with normal neck and supraclavicular soft tissue. 

Laboratory Results

Blood tests were unremarkable. Chest radiograph showed decreased left lung volume with compression (Figure 3). 

What's Your Diagnosis?
(Answer, discussion, and podcast on next page)

Answer: Shoulder Girth Lipomatosis

History

A middle-aged man came to the ambulatory clinic with left side chest discomfort and painless increase in girth of his left shoulder for last decade (Figures 1 and 2). He reported no similar swelling of the other limbs nor was he living in area endemic to filariasis. He had no similar family history and he was lifetime non-alcoholic. Physical exam revealed asymmetric diffuse enlargement of the left shoulder and arm with normal neck and supraclavicular soft tissue. Blood tests were unremarkable. Chest radiograph showed decreased left lung volume with compression (Figure 3).

Outcome of the Case

A clinical diagnosis of shoulder girdle lipomatosis was made.¹ Unilateral shoulder girdle lipomatosis is extremely rare. Pathologically, there is intramuscular fat infiltration with mature adipocytes deposited between the muscle fibers. The management of lipomatosis is surgical removal via either direct excision (lipectomy) or liposuction, although recurrences often occur.

Rajeev Sharma, MD, discusses the case in this podcast:

References:

1. McEachern A, Janzen DL, O'Connell JX. Shoulder girdle lipomatosis. Skeletal Radiol

2. Carlin MC, Ratz JL. Multiple symmetric lipomatosis: treatment with liposuction. J Am Acad Dermatol. 1988;18:359-362.

3. Constantinidis J, Steinhart H, Zenk J, et al. Combined surgical lipectomy and liposuction in the treatment of benign symmetrical lipomatosis of the head and neck. Scand J Plast Reconstr Surg Hand Surg. 2003;37:90-96.