They describe the Copeman nodule as a subcutaneous adipose tissue herniation through the superficial fascia (also known as back mice or back mouse). They say that it is a common condition, present in almost 15% of back pain. They present a case report with ultrasound examination.
Notes on the article of:
Farina R, Foti P. V., Cocuzza G., Costanzo V., Costanzo G., Conti A., Palmucci S.
Copeman nodule: a case report.
JUltrasound. 2017 Apr 28;20(3):251-252. doi: 10.1007/s40477-017-0247-4. eCollection 2017 Sep. PubMed PMID: 28900527; PubMed Central PMCID: PMC5573698.
Department of Radiodiagnostic and Radiotherapy, University Hospital “Policlinico-Vittorio Emanuele”, Catania, Italy.
The “Copeman nodule” description
Farina et al. commented the work of Ries, Copeman, Herz and Bonner that studied what Farina’s group call the “Copeman nodule.”
Briefly, they describe the “Copeman nodule” as a subcutaneous adipose tissue herniation through the fascia. They say that it is a common condition, present in almost 15% of back pain.
Farina et al. case report
A 30-year-old female with chronic pain of the left lumbar region, just above the iliac crest, lasting for a year. Pain increased with left lateral decubitus and palpation.
The patient was checked to exclude osteo-articular, neurological and renal pathologies.
The ultrasound examination
The ultrasound examination showed subcutaneous adipose tissue herniation through the superficial muscular fascia.
It revealed the presence of a hypo-echoic formation (equal to the adipose tissue), well circumscribed, penetrated into the muscle through a hernial gap of about 15.9 mm in diameter. No vascularization was observed.
The patient underwent surgery under local anaesthesia with suturing of the hernial gap, which produced an immediate regression of the symptoms.
The lipomas and angiolipomas do not cross the muscular fascia
Farina et al.’s differential diagnosis included lipomas and angiolipomas; nevertheless, the “Copeman nodule” is the only that crosses the muscular fascia.
The etiological causes of the “Copeman nodule” are not known. In this obese woman it could be due to the habit of wearing tight belts.
Published March 2018 by Marta Cañis Parera
- Ries E (1937) Episacroiliac lipoma. Amer J Obstet Gynec 34:490
- Copeman WS (1943) A Clinical Contribution to the Study of the aetiology of the Fibrositic Nodule. Ann Rheum Dis 3(4):222–226
- Copeman WS (1943) Aetiology of the Fibrositic Nodule. Br Med J 2(4312):263–264
- Herz R (1946) Herniation of subfascial fat as a cause of low back pain; results of surgical treatment in thirty-one cases. J Int Coll Surg 9:339–347
- Bonner CD, Kasdon SC (1954) Herniation of fat through lumbodorsal fascia as a cause of low-back pain. N Engl J Med 251:1102–1104