Ischemic stroke and incidental finding of a right atrial lipoma

Abstract

A young man presented with recurrent ischemic stroke under antiplatelet therapy. A patent foramen ovale (PFO) was diagnosed by transesophageal echocardiography (TEE) and the patient was referred to our institution for percutaneous closure. An echogenic mass in the right atrium was detected during the intraprocedural TEE. The interventional team decided to perform transcatheter closure of PFO under fluoroscopy and TEE guide, without complications. Subsequent cardiac magnetic resonance (CMR) imaging confirmed an encapsulated and hyperintense mass located in the roof of the right atrium. The signal intensity pattern and the absence of gadolinium contrast uptake allowed a confident diagnosis of lipoma. Cardiac lipoma accounts for about 10% of primary cardiac tumors and frequently rises from the epicardial fat tissue. Echocardiographic images can remain equivocal about the nature of the mass and CMR offers a substantial contribution to a correct diagnosis. The tumor usually appears encapsulated and asymptomatic, but dyspnea, atrial and ventricular arrhythmias and, rarely, peripheral embolization have been reported. To our knowledge, this is the second case reported on paradoxical embolization associated with right atrial lipoma. Although the relationship of cardiac lipoma with stroke is not well defined, the potential proembolic significance of this lesion cannot be excluded, especially when a PFO coexists.

Adipose tumors of the heart

“…The clinical manifestations of primary cardiac adipose tumors are usually not related to embolization, 7-14 although there have been a small number of case reports describing embolic events in these patients. 27,28 Our patient with an LV mass had intra-cardiac extensions of LHIS, but without documented emboli. The only neurological event seen in our patient was related to the brain tumor (meningioma), and not related to the cardiac tumor.…”

“…The clinical manifestations of primary cardiac adipose tumors are usually not related to embolization, although there have been a small number of case reports describing embolic events in these patients . Our patient with an LV mass had intra‐cardiac extensions of LHIS, but without documented emboli.…”

A Case of Asymptomatic Cardiac Lipoma and Literature Review

“…This can lead to formation of intracardiac thrombi and subsequent cardioembolic events such as strokes. 4 …”

“…This can lead to formation of intracardiac thrombi and subsequent cardioembolic events such as strokes. 4 Once a cardiac mass is incidentally discovered, further dedicated imaging is warranted to characterize the mass. TTE is often the first investigative modality due to its widespread availability.…”

Giant Cardiac Lipoma: Refined Hypothesis Proposes Invagination from Extracardiac to Intracardiac Sites

“…12 The tumors are typically found incidentally, because most patients with a cardiac lipoma are asymptomatic; however, valvular obstruction, cardiac compression, arrhythmias, and peripheral embolization can occur. 13,14 Only a few epicardial lipomas have been reported within the atria or compressing the ventricles. 15 To our knowledge, nothing unequivocally explains the presence within either atrium of adipocytes that are most typically found in extracardiac locations.…”