CTICasesIVC Lipoma with Fat Embolization during Attempted Percutaneous Retrieval
Imaging findings
A large intracaval lipoma had been growing within the inferior vena cava without causing symptoms. During an attempted endovascular snare retrieval, the mass could not be captured intact and fragmented, and the patient became acutely short of breath. Follow-up CT showed large, discrete fat-attenuation emboli within the pulmonary arteries, predominantly the left pulmonary artery with bilateral lower-lobe involvement, and the fragmented tumor ultimately required surgical extraction of large lipomatous chunks.
Key takeaways
Attempted percutaneous retrieval of a large intracaval fatty mass can fragment the tumor and cause large-volume, macroscopic fat pulmonary embolism, distinct from the microscopic fat emboli of classic fat embolism syndrome after long bone fracture. Recognizing bulky fat-attenuation filling defects in the pulmonary arteries following an interventional retrieval attempt should prompt consideration of iatrogenic tumor embolization from a fatty caval mass such as an IVC lipoma.
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