Presentation
Gradually increasing swelling in front of right ankle after excision of a tumor at the same region 3 years back
Patient Data
Large fat density lesion with a few thin internal septa is seen in intermuscular plane in between tibialis anterior and extensor hallucis longus muscle medially and extensor digitorum longus laterally. The fat density SOL abuts the deep fascia of leg at places anteriorly. The SOL extends inferiorly crossing the level of ankle joint. At the level of ankle joint the SOL herniates into the subcutaneous plane through a gap of adjacent deep fascia, possibly created by old surgical intervention.
Case Discussion
Intermuscular lipoma are often large SOL mostly found in between the large muscles of lower extremity and often in middle aged men. The case is typical of intermuscular lipoma. But the history suggests the importance of preoperative proper imaging workout. Without proper imaging the patient was operated to remove a small tumor at around ankle where it was palpable 3 years back. After the local excision of part of the lipoma, the lipoma grows through the fascial defect created by the operative procedure , and presented as a larger subcutaneous mass.
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