Paracaval lipoma

Changed by Andrea Molinari, 18 Nov 2023

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A paracaval lipoma (also known as juxtacaval fat collection or pseudolipoma of the inferior vena cava) refers to an apparent protrusion of paracaval fat into the inferior vena cava (IVC) and is commonly visible on CT; some believe it to be a normal anatomic variant ⁵¹.

Epidemiology

Paracaval lipoma may be seen in up to 0.5% of CT examinations ¹².

Associations

It may be seen in patients with cirrhosis ⁴³.

Pathology

The paracaval lipoma appearance is thought to be due to volume averaging through inwards and upwards indrawing of the posteromedial wall of the inferior vena cava as a result of negative pressure created within the thorax on inspiration ²⁴.

Radiographic findings

CT

Paracaval lipoma occurs at the medial aspect of the intrahepatic portion of the inferior vena cava (IVC) above the caudate lobe and represents pericaval fat appearing to invaginate into theinferior vena cava. Attenuation values is measure usually falls the in the compatible with macroscopic fat.

Ultrasound

In some situations may be seen as a echogenic, homogeneous nodule in the hepatic segment of the IVC at its junction with the right atrium ⁹⁵.

Differential diagnosis

On imaging consider

bland thrombus in the inferior vena cava
tumour thrombus
tumours of the inferior vena cava, e.g. leiomyosarcoma ³⁶

-<p>A<strong> paracaval lipoma</strong> (also known as <strong>juxtacaval fat collection</strong> or <strong>pseudolipoma of the inferior vena cava</strong>) refers to an apparent protrusion of paracaval fat into the <a href="/articles/inferior-vena-cava-1">inferior vena cava (IVC)</a> and is commonly visible on CT; some believe it to be a <a href="/articles/anatomical-variants">normal anatomic variant</a> <sup>5</sup>. </p><h4>Epidemiology</h4><p>Paracaval lipoma may be seen in up to 0.5% of CT examinations <sup>1</sup>.</p><h5>Associations</h5><p>It may be seen in patients with <a href="/articles/cirrhosis">cirrhosis</a> <sup>4</sup>. </p><h4>Pathology</h4><p>The paracaval lipoma appearance is thought to be due to volume averaging through inwards and upwards indrawing of the posteromedial wall of the inferior vena cava as a result of negative pressure created within the thorax on inspiration <sup>2</sup>.</p><h4>Radiographic findings</h4><h5>CT</h5><p>Paracaval lipoma occurs at the medial aspect of the intrahepatic portion of the inferior vena cava (IVC) above the caudate lobe and represents pericaval fat appearing to invaginate into the<a href="/articles/inferior-vena-cava-1"> </a>inferior vena cava. Attenuation values is measure usually falls the in the compatible with macroscopic fat. </p><h5>Ultrasound</h5><p>In some situations may be seen as a echogenic, homogeneous nodule in the hepatic segment of the IVC at its junction with the right atrium <sup>9</sup>. </p><h4>Differential diagnosis</h4><p>On imaging consider</p><ul>
~~-<li>~~
~~-<a href="/articles/bland-thrombus">bland thrombus</a> in the inferior vena cava</li>~~
~~-<li>~~
~~-<a href="/articles/tumour-thrombus">tumour thrombus</a><ul>~~
~~-<li><a href="/articles/renal-cell-carcinoma-1">renal cell carcinoma (RCC)</a></li>~~
~~-<li><a href="/articles/hepatocellular-carcinoma">hepatocellular carcinoma (HCC)</a></li>~~
~~-<li><a href="/articles/adrenal-cortical-carcinoma-1">adrenal carcinoma </a></li>~~
~~-</ul>~~
~~-</li>~~
~~-<li>tumours of the inferior vena cava, e.g. <a href="/articles/inferior-vena-cava-leiomyosarcoma">leiomyosarcoma</a> <sup>3</sup>~~
~~-</li>~~
+<p>A<strong> paracaval lipoma</strong> (also known as <strong>juxtacaval fat collection</strong> or <strong>pseudolipoma of the inferior vena cava</strong>) refers to an apparent protrusion of paracaval fat into the <a href="/articles/inferior-vena-cava-1">inferior vena cava (IVC)</a> and is commonly visible on CT; some believe it to be a <a href="/articles/anatomical-variants">normal anatomic variant</a> <sup>1</sup>. </p><h4>Epidemiology</h4><p>Paracaval lipoma may be seen in up to 0.5% of CT examinations <sup>2</sup>.</p><h5>Associations</h5><p>It may be seen in patients with <a href="/articles/cirrhosis">cirrhosis</a> <sup>3</sup>. </p><h4>Pathology</h4><p>The paracaval lipoma appearance is thought to be due to volume averaging through inwards and upwards indrawing of the posteromedial wall of the inferior vena cava as a result of negative pressure created within the thorax on inspiration <sup>4</sup>.</p><h4>Radiographic findings</h4><h5>CT</h5><p>Paracaval lipoma occurs at the medial aspect of the intrahepatic portion of the inferior vena cava (IVC) above the caudate lobe and represents pericaval fat appearing to invaginate into the<a href="/articles/inferior-vena-cava-1"> </a>inferior vena cava. Attenuation values is measure usually falls the in the compatible with macroscopic fat. </p><h5>Ultrasound</h5><p>In some situations may be seen as a echogenic, homogeneous nodule in the hepatic segment of the IVC at its junction with the right atrium <sup>5</sup>. </p><h4>Differential diagnosis</h4><p>On imaging consider</p><ul>
+<li><p><a href="/articles/bland-thrombus">bland thrombus</a> in the inferior vena cava</p></li>
+<li>
+<p><a href="/articles/tumour-thrombus">tumour thrombus</a></p>
+<ul>
+<li><p><a href="/articles/renal-cell-carcinoma-1">renal cell carcinoma (RCC)</a></p></li>
+<li><p><a href="/articles/hepatocellular-carcinoma">hepatocellular carcinoma (HCC)</a></p></li>
+<li><p><a href="/articles/adrenal-cortical-carcinoma-1">adrenal carcinoma</a></p></li>
+</ul>
+</li>
+<li><p>tumours of the inferior vena cava, e.g. <a href="/articles/inferior-vena-cava-leiomyosarcoma">leiomyosarcoma</a> <sup>6</sup></p></li>

References changed:

1. Raju N & Austin J. Case 37: Juxtacaval Fat Collection--Mimic of Lipoma in the Subdiaphragmatic Inferior Vena Cava. Radiology. 2001;220(2):471-4. <a href="https://doi.org/10.1148/radiology.220.2.r01au12471">doi:10.1148/radiology.220.2.r01au12471</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/11477255">Pubmed</a>
2. Han B, Im J, Jung J, Chung M, Yeon K. Pericaval Fat Collection That Mimics Thrombosis of the Inferior Vena Cava: Demonstration with Use of Multi-Directional Reformation CT. Radiology. 1997;203(1):105-8. <a href="https://doi.org/10.1148/radiology.203.1.9122375">doi:10.1148/radiology.203.1.9122375</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/9122375">Pubmed</a>
3. Smillie R, Shetty M, Boyer A, Madrazo B, Jafri S. Imaging Evaluation of the Inferior Vena Cava. Radiographics. 2015;35(2):578-92. <a href="https://doi.org/10.1148/rg.352140136">doi:10.1148/rg.352140136</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/25763740">Pubmed</a>
4. Kandpal H, Sharma R, Gamangatti S, Srivastava D, Vashisht S. Imaging the Inferior Vena Cava: A Road Less Traveled. Radiographics. 2008;28(3):669-89. <a href="https://doi.org/10.1148/rg.283075101">doi:10.1148/rg.283075101</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/18480478">Pubmed</a>
5. Chou Y, Chiou H, Tiu C, Chiang J, Chang C, Yu C. Sonographic Appearance of Lipoma of the Inferior Vena Cava. J Clin Ultrasound. 2001;29(6):359-62. <a href="https://doi.org/10.1002/jcu.1049">doi:10.1002/jcu.1049</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/11424103">Pubmed</a>
6. Kaufman L, Yeh B, Breiman R, Joe B, Qayyum A, Coakley F. Inferior Vena Cava Filling Defects on CT and MRI. AJR Am J Roentgenol. 2005;185(3):717-26. <a href="https://doi.org/10.2214/ajr.185.3.01850717">doi:10.2214/ajr.185.3.01850717</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/16120925">Pubmed</a>
1. Han B, Im J, Jung J, Chung M, Yeon K. Pericaval Fat Collection That Mimics Thrombosis of the Inferior Vena Cava: Demonstration with Use of Multi-Directional Reformation CT. Radiology. 1997;203(1):105-8. <a href="https://doi.org/10.1148/radiology.203.1.9122375">doi:10.1148/radiology.203.1.9122375</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/9122375">Pubmed</a>
2. Kandpal H, Sharma R, Gamangatti S, Srivastava D, Vashisht S. Imaging the Inferior Vena Cava: A Road Less Traveled. Radiographics. 2008;28(3):669-89. <a href="https://doi.org/10.1148/rg.283075101">doi:10.1148/rg.283075101</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/18480478">Pubmed</a>
3. Kaufman L, Yeh B, Breiman R, Joe B, Qayyum A, Coakley F. Inferior Vena Cava Filling Defects on CT and MRI. AJR Am J Roentgenol. 2005;185(3):717-26. <a href="https://doi.org/10.2214/ajr.185.3.01850717">doi:10.2214/ajr.185.3.01850717</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/16120925">Pubmed</a>
4. Smillie R, Shetty M, Boyer A, Madrazo B, Jafri S. Imaging Evaluation of the Inferior Vena Cava. Radiographics. 2015;35(2):578-92. <a href="https://doi.org/10.1148/rg.352140136">doi:10.1148/rg.352140136</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/25763740">Pubmed</a>
5. Raju N & Austin J. Case 37: Juxtacaval Fat Collection--Mimic of Lipoma in the Subdiaphragmatic Inferior Vena Cava. Radiology. 2001;220(2):471-4. <a href="https://doi.org/10.1148/radiology.220.2.r01au12471">doi:10.1148/radiology.220.2.r01au12471</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/11477255">Pubmed</a>
6. Pan X, Saida Y, Kurosaki Y, Onaya H, Itai Y. Fatty Mass in the Inferior Vena Cava at CT: Lipoma or Normal Variant? Radiat Med. 1995;13(5):251-3. - <a href="https://www.ncbi.nlm.nih.gov/pubmed/8848561">Pubmed</a>
7. Grassi R, Di Mizio R, Barberi A, Severini S, Del Vecchio A, Cappabianca S. Case Report. Ultrasound and CT Findings in Lipoma of the Inferior Vena Cava. Br J Radiol. 2002;75(889):69-71. <a href="https://doi.org/10.1259/bjr.75.889.750069">doi:10.1259/bjr.75.889.750069</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/11806961">Pubmed</a>
8. Katz D & Goffner L. "Lipoma" of the Inferior Vena Cava is Actually a Pericaval Fat Collection. J Clin Ultrasound. 2002;30(1):57-8. <a href="https://doi.org/10.1002/jcu.10020">doi:10.1002/jcu.10020</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/11807858">Pubmed</a>
9. Chou Y, Chiou H, Tiu C, Chiang J, Chang C, Yu C. Sonographic Appearance of Lipoma of the Inferior Vena Cava. J Clin Ultrasound. 2001;29(6):359-62. <a href="https://doi.org/10.1002/jcu.1049">doi:10.1002/jcu.1049</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/11424103">Pubmed</a>
10. Greenhill M, Gnecco IV J, Ahmed I. Paracaval Lipoma: Case Study and Literature Review. Radiology Case Reports. 2019;14(4):518-20. <a href="https://doi.org/10.1016/j.radcr.2018.07.020">doi:10.1016/j.radcr.2018.07.020</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/30906489">Pubmed</a>