Pelvic lipomatosis is a non-malignant condition of unknown etiology characterized by an overgrowth of non-encapsulated fatty tissue in the perirectal and perivesical spaces of the pelvis. The symptoms are generally vague and the condition is often diagnosed accidentally. It may cause obstruction of the ureters, inferior vena cava and pelvic veins and may be associated with cystitis glandularis. The typical conventional radiographic findings, though not pathognomonic, are a high-positioned and pear-shaped bladder, tubular narrowing of the rectum and distal sigmoid colon and reduced attenuation of the pelvic soft tissues. Computed tomography demonstrates a non-encapsulated fatty mass surrounding the pelvic organs symmetrically and with an attenuation similar to that of subcutaneous fat. The fatty tissue may contain strands with a higher attenuation than that of fat. The findings at computed tomography seem to be pathognomonic for this condition and eliminate the need for routine surgical biopsies.