Case Study
Uwe Wollina
Posttraumatic painful subcutaneous oily cysts
Keywords | Summary | Correspondence | References
Keywords
adipose tissue, blunt trauma, oily cysts, pain
Schlüsselworte
Summary
Background: Blunt trauma may cause injuries of subcutaneous adipose tissue. Main observation: We observed a 23-year-old woman who developed a chronic pain after falling down a staircase. The pain was circumscribed and unilateral in the lumbar area. On palpation multiple dense nodules were noted. Surgery was performed which resulted in a complete remission of pain. Histopathological analysis revealed multiple oily cysts located in the subcutaneous adipose tissue. Conclusion: Posttraumatic oily cysts may rarely be associated with a chronic pain syndrome.
Zusammenfassung
Introduction
The response of adipose tissue to blunt trauma varies depending on the force and type of impact (right angle or tangent): Typical variants include perilobular hemorrhage, contusion, disintegration of fat lobuli, and disintegration with development of a subcutaneous cavity [1].
Posttraumatic fat necrosis may be followed by lipoatrophy [2]. Posttraumatic pseudolipoma and posttraumatic lipoma are other response pattern [3, 4]. Heterotopic bone formation – panniculitis ossificans traumatic – is a recently described entity [5]. Sometimes a chronic pain syndrome results from blunt injury to adipose tissue [2].
Fig. 1: Surgical specimen from the bottom of the lesion.
Fig. 2: Detail – oily cysts within the adipose tissue clearly separated by
morphology.
Case report
A 23-year old, otherwise healthy female presented with multiple painful subcutaneous nodules in the lumbar region. She had not taken any medications but reported an accident several months ago, were she had fallen down a staircase. The blunt trauma had not induced bony lesions or nerve damage.
Disclaimer: Nothing to disclaim.
Funding: No funding.
On examination we observed an area of about 25 x 6 cm just above her right crista iliaca with multiple small subcutaneous firm nodules. Their diameter was between 2 and 4 mm. The nodules were mobile but painful on pressure. No spontaneous pain occurred.
We performed a complete excision of the area with primary suturing. On gross morphology small cystic formations were noted (Fig. 1 and 2). The cysts contained an opaque yellowish, oily fluid. Histopathological examination confirmed the diagnosis of oily cysts. Wound healing was uneventful. She had a complete remission of the local chronic pain.
Discussion
Various histopathologic changes can be induced by blunt trauma. Chronic pain resulting from adipose tissue injury is rare. Only a single case has been reported previously (Crawford et al. 2009) [2]. Since the nodules themselves were not painful during surgery we suppose that under pressure they might have irritated local nerves.
The differential diagnosis of painful subcutaneous adipose tissue nodules includes angiolipomas, panniculitis, and Dercum’s disease among others [7–9]. Histopathologic analysis confirmed oily cysts in the present case. Oily cysts have been seen after lipofilling [10].
Conclusions
Posttraumatic oily cysts may be another rare condition associated with chronic pain syndrome. Surgery is a therapeutic option with rapid pain relief.
Address of Correspondence
Prof. Dr. Uwe Wollina
Department of Dermatology and Allergology
Academic Teaching Hospital Dresden-Friedrichstadt
Friedrichstra.e 41
D-01067 Dresden
Wollina-uw@khdf.de
References
1. Yen K, Vock P, Tiefenthaler B, Ranner G, Scheurer E, Thali MJ, Zwygart K, Sonnenschein M, Wiltgen M, Dirnhofer R. Virtopsy: forensic traumatology of the subcutaneous fatty tissue; multislice computed tomography (MSCT) and magnetic resonance imaging (MRI) as diagnostic tools. J Forensic Sci. 2004;49(4):799-806.
2. Crawford EA, King JJ, Fox EJ, Ogilvie CM. Symptomatic fat necrosis and lipoatrophy of the posterior pelvis following trauma. Orthopedics. 2009;32(6):444
3. Theumann N, Abdelmoumene A, Wintermark M, Schnyder P, Gailloud MC, Resnick D. Posttraumatic pseudolipoma: MRI appearances. Eur Radiol. 2005;15(9):1876-80.
4. S ignorini M, Campiglio GL. Posttraumatic lipomas: where do they really come from? Plast Reconstr Surg. 1998;101(3):699-705.
5. W ollina U, Koch A, Sch.nlebe J, Witzigmann H, Kittner T. Panniculitis ossificans of the lower leg. Int J Low Extrem Wounds. 2009; 8(3):165-8.
6. B oyd AS. Panniculitis ossificans traumatica of the lower leg. Am J Dermatopathol. 2011;33(8):858-60.
7. Kumar SP, Kamath SM, Prasad ALS, Mysorekar VV, Sumathy TK. Acute-onset of multiple painful nodules over forearms and back. J Clin Diagn Res. 2013; 7(10): 2314–6.
8. Z elger B. Panniculitides, an algorithmic approach. G Ital Dermatol Venereol. 2013;148(4):351-70. PMID 23900258
9. H ansson E, Svensson H, Brorson H. Review of Dercum’s disease and proposal of diagnostic criteria, diagnostic methods, classification and management. Orphanet J Rare Dis. 2012;7:23.
10. Fiaschetti V, Pistolese CA, Fornari M, Liberto V, Cama V, Gentile P, Floris M, Floris R, Cervelli V, Simonetti G. Magnetic resonance imaging and ultrasound evaluation after breast autologous fat grafting combined with platelet-rich plasma. Plast Reconstr Surg. 2013;132(4):498e-509e.
