Massive localised lymphoedema: clinical presentation and MR imaging characteristics

Three morbidly obese women were referred to us with suspected soft-tissue sarcomas. All lesions arose from the medial subcutaneous tissues of the thigh, and were shown to represent massive localised lymphoedema (MLL), a rare condition occurring in morbidly obese adults. MR imaging typically demonstrates a sharply demarcated, pedunculated mass consisting of fat partitioned by fibrous septae surrounded by a thickened dermis. There is oedema both within the mass and tracking along the subcutaneous septae in a “lace-like” fashion outwards from the pedicle, outlining large lobules of fat. Minimal enhancement is observed within the dermis of the lesion following intravenous gadolinium administration. Obesity is a growing problem that is likely to result in an increase in the prevalence of this condition; therefore, familiarity with the radiological appearance is important in establishing a correct diagnosis in this condition that may mimic a soft-tissue sarcoma.