CLINICAL NOTE A Rare Prevertebral Ordinary Lipoma Presenting as Obstructive Sleep Apnea Computed Tomographic and Magnetic Resonance Imaging Findings Jean Anderson Eloy, MD; Eduarda Carneiro, MD; Prasanna Vibhute, MD; Eric M. Genden, MD; Joshua B. Bederson, MD; Peter M. Som, MD L ipomas are among the most common benign tumors of mesenchymal origin, having been described in virtually every area of the body. 1-7 We describe a 65-year-old woman presenting with snoring and obstructive sleep apnea (OSA) secondary to a prevertebral cervical lipoma that extended into the right parapharyngeal space and into the spinal canal through the right C2-C3 neural foramen. Only 1 prior similar case has been reported in the English literature. 8 Complete surgical removal of the lesion was performed through a lateral cer- vical approach. REPORT OF A CASE A 65-year-old woman with no significant medical history presented to our Head and Neck Cancer Center with worsening snor- ing and OSA. Results of the physical exami- nation showed right posterior pharyngeal wall fullness with diminution of the oro- pharyngeal airway. Computed tomo- graphic (CT) imaging (Figure 1) showed a fatty attenuation consisting of a lobu- lated prevertebral mass that displaced the right posterior oropharyngeal wall for- ward, minimally displaced the right ca- rotid sheath laterally, and extended into the right C2-C3 neural foramen. Magnetic reso- nance (MR) imaging (Figure 2) showed the mass to have signal intensities consis- tent with fat. The patient underwent surgi- cal excision of the lesion via a lateral trans- cervical approach. Her postoperative course was unremarkable, and she was dis- charged on the second postoperative day in stable condition. At present, the patient is healthy with complete resolution of her snoring and OSA. Findings from pathologi- cal examination of the excised specimen showed an ordinary lipoma. COMMENT Lipomas are generally encapsulated sub- cutaneous or submucosal masses that pri- marily arise in the superficial soft tissues. As such, they are referred to as ordinary lipomas. 1 There is also an infiltrating or intramuscular type of lipoma that infil- trates surrounding skeletal muscles and tis- sues, has an incomplete capsule, and has a high rate of recurrence after resection. 2 Only 13% to 15% of lipomas present in the head and neck, with the posterior tri- angle of the neck being the most com- mon affected site. However, the anterior neck, infratemporal fossa, oral cavity, phar- ynx, and larynx also may be involved. 3 Li- pomas posterior to the pharynx are un- common, with only about 30 cases described since the late 1800s. 3 Preverte- bral lipomas are rare, and owing to their clinically inaccessible location, CT and/or MR imaging are important tools for their pretreatment diagnosis. However, be- cause liposarcomas can occasionally ap- pear similar to lipomas on CT and MR imaging, histological confirmation is es- sential for a definitive diagnosis. The 3 spaces behind the pharynx in which such a lipoma might arise include the retropharyngeal space, the danger space, and the prevertebral space. Most reported cases of lipomas in this area have been de- scribed as arising in the retropharyngeal Author Affiliations: Departments of Otolaryngology–Head and Neck Surgery (Drs Eloy, Genden, and Som), Radiology (Drs Vibhute and Som), and Neurosurgery (Dr Bederson), Mount Sinai School of Medicine, and Head and Neck Cancer Center, Mount Sinai Medical Center (Drs Genden and Som), New York, New York; and Department of Neuroradiology, Sa˜o Joao Hospital, Porto, Portugal (Dr Carneiro). (REPRINTED) ARCH OTOLARYNGOL HEAD NECK SURG/ VOL 134 (NO. 9), SEP 2008 WWW.ARCHOTO.COM 1001 ©2008 American Medical Association. All rights reserved.