Images in Vascular Medicine: Intravascular lipoma of a common femoral vein - an uncommon cause of recurrent deep vein thrombosis

A 73-year-old woman with a history of recurrent deep vein thrombosis of the left lower extremity, which occurred approximately 7 and 5 years previously, was admitted for placement of a caval filter prior to surgery to repair a left femur fracture. Physical examination revealed edema and swelling of the left leg, and color Doppler ultrasonography (US) documented a floating oval lesion in the left common femoral vein (online supplementary video). Subsequently, computed tomography (CT) of the abdomen demonstrated a filling defect in the left femoral vein, supported by an oval formation with sharp margins and fat attenuation, with axial dimensions of 19 × 16 mm. A multistep therapeutic approach, including caval filter placement, anticoagulation with subcutaneous low-molecular-weight heparin and surgical excision, was performed to reduce the risk of thromboembolism, establish the pathologic diagnosis, and prevent complications arising from this tumor. After placement of the caval filter, surgical excision was performed, and the patient was found to have an extrinsic adipose formation infiltrating the postero-lateral wall of the femoral vein, in continuity through a wall breach with an adipose mass occluding the venous lumen. The mass was resected, and the venous breach was repaired with a Prolene 6/0 continuous suture. Histologic examination revealed a lipomatous, partially capsular lesion without evidence of cellular atypia, consistent with lipoma.