Asymptomatic cardiac lipoma originating from the interventricular septum diagnosed by multi-slice computed tomography

Abstract

A 45 year-old asymptomatic man was admitted to preoperative cardiovascular evaluation for noncardiac surgery. Physical examination and ECG were normal. Transthoracic echocardiography showed a 17 x 35 mm suspicious hyperechoic mass in the interventricular septum. Multi-slice computed tomography (MSCT) was used. Volume rendered image and an axial maximal intensity projection image demonstrated a mass with a density consistent with fat tissue ( - 78 HU). The MSCT findings were diagnostic of a benign lipoma. Thus, this mass was noninvasively diagnosed as cardiac lipoma. Neither life-threatening arrhythmia on Holter monitoring nor myocardial ischemia on exercise scintigraphy was observed.Transthoracic echocardiography is usually the initial diagnostic test in patients with a suspected cardiac mass. However, its sensitivity for differentiating tissue characteristics is limited. MSCT allow for detailed delineation of intra and pericardiac masses. In conclusion, we demonstrated the value of cardiac MSCT to diagnose an interventricular lipoma.

Adipose tumors of the heart

“…The initial diagnosis is usually established by echocardiography. CT scan and cardiac MRI are usually subsequently performed and may help elucidate the nature of the tissue (ie, lipomatous tissue) and extent of infiltration . Sometimes, however, as observed in our experience, the mass is not identified until surgery is undertaken for other reasons.…”

“…[11][12] Surgical resection is recommended for most patients unless a cardiac lipoma is diagnosed incidentally, without associated symptoms, life-threatening arrhythmias, or signs of myocardial ischemia. 16 We present a single-center experience with surgical treatment of six primary cardiac adipose tumors, encompassing both lipomas and LHIS, and describe differences between the two pathologic types and demonstrate that "LHIS" may also occur in non-traditional sites.…”

“…The clinical differentiation of the two pathologic entities is not possible in most patients . Surgical resection is recommended for most patients unless a cardiac lipoma is diagnosed incidentally, without associated symptoms, life‐threatening arrhythmias, or signs of myocardial ischemia …”

Ressecção de um lipoma de átrio direito e reconstrução parcial com pericárdio bovino

“…The intracardiac tumors may provoke disorders of atrioventricular or intraventricular conduction, which are manifested by arrhythmias, interfering in the cardiac dynamic, leading to sudden death [1,7]. Many cases are data from autopsy findings, since the disease progressed asymptomatic in some cases, resulting from size and location of the tumors [6].…”

Lipoma of the right atrium

“…3 They may involve the endocardium, the myocardium, and the pericardium. 4 Approximately 50% of these tumors have a subendocardial origin, 25% have an intramyocardial origin (affecting most frequently the left ventricle, right atrium, and the interatrial septum), and the remaining 25% have a pericardial origin. 5 Although they may be asymptomatic for years, they may present with cardiac symptoms and signs from intracardiac obstruction, which depend on the size and location of the tumors.…”