Pagonis et al. Journal of Medical Case Reports 2011, 5:552 http://www.jmedicalcasereports.com/content/5/1/552 Page 3 of 5 Figure 2 MRI picture showing one of the recesses invading the carpal tunnel. this kind of tumor might be an indication of a high rate of misdiagnosis. Apart from cosmetic reasons the only indication for surgical treatment is the existence of com- plications arising from compression of local neurovascu- lar structures which is a high occurrence in the narrow Figure 3 The lipoma was excised en block. spaces within the fascial sheaths demarcating the regions of the hand. Soft tissue lipomas are categorized by anatomic loca- tion as either superficial (subcutaneous) or deep and their contour is determined by the confines of the space the tumor occupies. When there is no limiting fascia, muscle, bone or organ, the lipoma is usually round. Fat tumors however have the ability to insinuate themselves into small recesses and thus produce tumors of any size or shape, infiltrating spaces not tightly guarded by pro- tecting sheaths as fascia. This is especially true with tumors of the hand where lipomas occur in various ana- tomic locations within it. Superficial lipomas arise in the subcutaneous tissues while deep lipomas arise in the Guyon’s canal, in the carpal tunnel, and the deep palmar space. Brand and Gelberman [7] advocated the addition of deep palmar lipomas to the list of the possible causes of carpal tunnel syndrome as was the case with our patient. The deep-embedded and intramuscular lipomas are less defined, considerably larger in size, and much less common than their superficial counterparts [8] due to the thick palmar fascia obscuring the true size and extent of these tumors. Consequently, the required sur- gery may be more extensive than originally planned, due to the anatomy usually being distorted. Good results can be obtained with surgical treatment, but, as with large tumors located elsewhere, these require a thorough pre- operative assessment [9]. MRI scan is very helpful in planning surgery as it clearly shows the extent of the tumor and its relation to important structures [10]. A previous analysis of 134 cases revealed that MRI gave