Presentation
Swelling of the posterior left thorax since childhood, which was growing slowly. Pain in the posterior left thorax for the last 2 months.
Patient Data
CT thorax acquired in the prone position.
Marked fatty hypertrophy of the left postero-lateral thoracic muscles:
fatty hypertrophy of intercostal muscle of 2nd and 3rd intercostal spaces
fatty component extends in the cervical region involving the left posterior triangle
Hypertrophy of left 3rd rib, left transverse process, left pedicle, and the left half of the
3rd thoracic vertebra. Enlarged left facet joint at the 3-4th thoracic level with adjacent intervertebral foraminal narrowing. Cortical irregularities of left 3rd rib and the left transverse process of the 3rd thoracic vertebra.
Case Discussion
Localized gigantism due to fatty hypertrophy of muscles and hypertrophy of adjacent bones of the posterior left hemithorax since childhood suggests the diagnosis of macrodystrophia lipomatosa of the posterior thorax caused by lipomatosis of the intercostal nerve. Neural foraminal narrowing resulting from bone overgrowth is the likely cause of recent onset of neurogenic pain.
This condition almost always affects limbs with distal predilection and overgrowth of mesenchymal structures. Axial nerves are rarely affected 1.
Additional contributor Dr Dijendra Nath Biswas
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