Madelung disease: manifestations of CT and MR imaging

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The purpose of the present study was to assess the head and neck imaging features of Madelung disease on computerized tomography (CT) and magnetic resonance imaging (MRI), delineate the effects of the fatty deposits on underlying structures, and tabulate the anatomic sites where the neck fat was deposited. Sixteen Chinese patients with Madelung disease in our hospital were reviewed. The CT manifestations of the 16 cases and the MRI manifestations of 1 case were analyzed retrospectively. The imaging features of the fatty distribution in the head and neck area were studied. Cross-sectional CT showed that the excess fat was symmetric and unencapsulated, mainly deposited at the anterior or posterior subcutaneous tissue of the neck, was deep under the sternocleidomastoid and trapezius muscles, was situated in the posterior cervical triangle, and was around the salivary glands. It was also found to be situated in supraclavicular fossa, around the paraspinal muscles and larynx, and so on. The accumulated fat at superficial sites was situated at the napex and/or at the anterior neck, forming small or large fatty masses to protrude backwards locally or sometimes at submentum; the markedly thickened neck might appear tubby or oval in anteroposterior diameter. The accumulated fat at deep sites compressed adjacent muscles, salivary glands, and great vessels and caused them to shift and deform. The distinctive appearance was that marked thickening of fat caused sternocleidomastoid muscles and submaxillary glands to shift forward obviously, like a bird spreading its wings. The density of the abnormally proliferated fat was equal to that of normal fat. In MRI, the distribution of the excess fat was equal to that seen with CT. The signal intensity of the excess fat was equal to that of normal fat. Besides the accumulation of the neck fat tissue, CT and MRI did not show other abnormal soft tissue masses. The use of CT and MRI can accurately show the excess fat based on density of CT and signal intensity of MRI. The density and signal intensity of the excess fat are equal to those of normal fat. The excess fat, mainly deposited at the anterior or posterior subcutaneous tissue of the neck, was deep under the sternocleidomastoid and trapezius muscles, was situated in the posterior cervical triangle, and was around the salivary gland, and so on. CT and MRI can also show compression, shift, and deformation of surrounding salivary glands, great vessels, and muscles caused by the excess fat. The CT and MRI can accurately diagnose the disease and exclude other soft tissue tumors.