Giant Lipoma of the Neck Causing Airways Compression: A Case Report

ABSTRACT Introduction Lipomas are benign soft tissue masses that typically do not cause significant health issues. Surgical removal is often performed for cosmetic reasons or, less commonly, to address complications resulting from mass effects. We present a clinical case of a woman with a giant bilateral cervical lipoma, which led to airway obstruction and required complex surgical intervention. Case Report The patient, a woman with a giant bilateral lipoma of the neck, developed nocturnal dyspnea lasting approximately 6 days due to the compressive effect of the mass on the airway. Surgical resection was planned to relieve the airway obstruction. Following the incisional biopsy and extubation, the patient experienced laryngospasm, which led to airway compromise and anoxia, resulting in a brief (2‐min) cardiovascular arrest. Prompt resuscitation was performed, and a tracheostomy was placed to secure the airway. Surgery was delayed for 3 weeks to stabilise the patient before proceeding with the resection. The lipoma's location posed significant surgical challenges due to its close relationship with critical structures, including the vascular and neural bundles of the neck, the trachea anteriorly, and the aortic arch and pulmonary apices inferiorly. The resection was completed without further complications (mass size of 6 × 15 × 17 cm, 1210 g)., and the airway compression was successfully relieved. Two days postoperatively, the tracheostomy cannula was removed without incident. Discussion Cervical lipomas with mediastinal extension are rare and may present significant surgical challenges due to their proximity to vital structures. Large masses can lead to symptoms such as dysphagia, dyspnea, and potentially life‐threatening complications. In this case, the development of nocturnal dyspnea prompted early surgical intervention, with biopsy performed to exclude malignancy. The perioperative course was complicated by post‐extubation laryngospasm and cardiac arrest, but the patient was successfully resuscitated, and the airway was secured with a tracheostomy. Bilateral cervical access was essential for safe dissection around the trachea, vascular structures, and oesophagus, allowing for complete removal of the mass. Histopathological examination confirmed the benign nature of the lipoma. Conclusion This case illustrates that large cervical lipomas, despite their benign nature, can lead to severe clinical complications if they cause significant airway compression. While surgical resection remains the treatment of choice, such cases require careful multidisciplinary planning, particularly in the perioperative period, to manage potential risks associated with the proximity of the tumour to critical anatomical structures.