816 - Hidden Beneath the Surface: Unveiling a Gluteal Lipoma's Role in Low Back Pain: A Case Report

Thursday, February 22, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

DE

Diana O. Ekechukwu, MD

Resident Physician
The University of Texas Health Science Center at Houston
Houston, Texas, United States

Co-Author(s)

VB

Vishal Bansal, MD

Resident Physician
UTHealth
Houston, Texas, United States

Corresponding Author(s)

KP

Kemly Philip, MD PhD

Assistant Professor
McGovern Medical School at UTHealth
Bellaire, Texas, United States

Case Diagnosis: Gluteal Lipoma

Case Description: 76-year-old female with history of atrial fibrillation who presented with a five-week history of acute on chronic low back pain (LBP) referred to her left leg. She presented to the emergency department twice before for pain relief. CT-AP was remarkable for 11.3 x 8.8 x 6.4 cm lipoma in the left gluteal compartment. CT lumbar spine revealed lumbar spondylosis and bulging discs at L4-L5 and L5-S1. She was discharged with oral analgesics and corticosteroids, which failed to provide relief, and was referred to interventional pain. Physical exam showed intact motor strength but was positive for tenderness to palpation of a left-sided gluteal mass and lower paravertebral musculature and hypersensitivity of the left L4-dermatome. She also complained of left greater trochanteric bursa (GTB) pain. Provocative maneuvers were modestly positive for left-sided radicular pain.

Discussions: Due to pacemaker placement, CT myelogram was ordered for further investigation of lumbar pathology and is pending. She was scheduled for a left GTB injection to rule out hip pathology and referred to orthopedic oncology for further evaluation of the large gluteal lipoma within her greater sciatic notch.

Few published case reports exist detailing the presence of gluteal lipomas in the setting of LBP, and patients typically experience pain relief with surgical excision or injections into the lipoma. Lipomas are thought to be extrinsic pain generators due to interaction with surrounding structures (i.e., nerves or bursa). This case highlights the complexities involved in assessing LBP. Symptoms and diagnostic imaging initially suggested radiculopathy, but the patient’s physical exam was equivocal, leading to a broader differential diagnosis.

Conclusions: Physiatrists should consider the presence of gluteal lipomas in patients presenting with LBP accompanied by radiculitis as a less common yet plausible etiology of their symptoms in order to improve quality of life and reduce costly work-up.