# A Case of Right Superior Lumbar Hernia in an Elderly Woman: Differentiation from Lipoma in an Outpatient Setting with Bedside Ultrasonography

## TL;DR

An elderly woman's rare right superior lumbar hernia was correctly diagnosed using bedside ultrasound, avoiding misdiagnosis as a lipoma.

## Contribution

Demonstrates the utility of bedside ultrasonography in diagnosing rare lumbar hernias in non-surgical outpatient settings.

## Key findings

- Bedside ultrasonography identified a fascial defect and retroperitoneal fat, confirming a superior lumbar hernia.
- The lesion remained stable over 18 months with conservative management due to no signs of incarceration.
- Postural variation and fascial defects are key features to differentiate hernias from lipomas in elderly patients.

## Abstract

Superior lumbar hernias (Grynfeltt’s hernias) are a rare type of abdominal wall hernia that may be under-recognized, particularly, by non-surgical physicians, because of their subtle and non-specific presentation. We report a case of an 82-year-old woman with a right-sided superior lumbar hernia initially suspected as a lipoma. The patient presented with a soft, painless mass on her right upper back that varied with posture, becoming prominent when standing and disappearing when supine. Physical examination showed a soft, mobile, non-tender subcutaneous mass. Although initially thought to be a lipoma, bedside ultrasonography revealed retroperitoneal fat protruding through a fascial defect without bowel involvement. Computed tomography confirmed the diagnosis of a right superior lumbar hernia. Because there were no symptoms or signs of incarceration, conservative management was chosen. The lesion remained stable over an 18-month follow-up. This case emphasizes key differentiating features―such as postural variation and fascial defects―that can help distinguish lumbar hernia from lipoma, especially in outpatient internal medicine settings. Most reported lumbar hernia cases rely on computed tomography, which is the gold standard for diagnosis, but this case demonstrates that bedside ultrasonography can also be highly useful for early recognition. Given that non-surgeons often encounter subcutaneous masses in elderly patients, awareness of lumbar hernia as a differential diagnosis is critical. This case illustrates that careful physical examination, combined with bedside imaging, can lead to accurate diagnosis, even in non-surgical settings. Highlighting these distinguishing features can help non-surgical physicians avoid misdiagnosis of this rare but clinically relevant condition and improve early detection in general medical practice.