We report the case of a 56-year-old man with a 35-year history of alcohol abuse and no other associated pathology.
The patient came to our Plastic and Reparative Surgery Service of Carlos Haya de Málaga Hospital (Spanish) with progressive masses in the shoulders, breasts and flanks that had increased in size.
Physical examination revealed soft, non-painful masses, with no well-defined borders, located on both shoulders, breasts, lumbar fossae and flanks without cervical involvement (Madelung's bullet).
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In the radiological study using axial sequences of Computerized Axial Tomography (CAT), an excess of fat deposit of homogeneous distribution unencapsulated (diffuse) over the abdominal structures, without involvement of the breasts was observed.
Likewise, no mediastinal or anterior cervical fat deposits were found.
Since the patient had been operated on for inguinal hernia and incisional hernia, an abdominal Magnetic Resonance Imaging (MRI) was performed to assess the integrity of the abdominal wall.
Sections were made in the three planes of space with sequences potentiated in SE T1, TSE T2 and Stir, observing a correct arrangement of the abdominal muscles, a significant diffuse increase of subcutaneous cellular tissue abdominal fat and absence of abdominal fat.
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Histopathological study reported non-encapsulated fatty deposits with non-pathological adipocytes.
After completing these data with anamnesis and physical examination, the definitive diagnosis was Madelung's Disease or Benign Symmetric Lipomatosis type II.
The proposed surgical treatment was liposuction of the fat pads located in the abdomen, lumbar area and shoulders and dermolipectomy in both breasts.
The patient refused both procedures, so weight loss and alcohol withdrawal were advised, even knowing its limited benefits.
