Benign cardiac tumours are rare and cardiac lipomas account only for a small fraction among those. Most of these tumours differ in terms of clinical manifestation, diagnosis, morphology and size, and are therefore not diagnosed easily unless they become symptomatic. We report the case of a 71-year-old Caucasian woman with recurrent episodes of shortness of breath presenting with an acute exacerbation of dyspnoea and hypertensive crisis. Diagnosis of a right atrial lipoma with a coexisting patent foramen ovale was established on echocardiography and computed tomography, and the patient was evaluated for elective surgery. Comprising the entire free wall of the right atrium, the tumour was removed during open heart surgery on cardiopulmonary bypass. The right atrium and the orifices of both the superior and inferior vena cava were reconstructed with bovine pericardium. No evidence of tumour relapse was observed during successive follow-up visits. Benign cardiac tumours are rare and lipomas represent only a minor percentage among those. 1 The incidence of primary tumours of the heart and pericardium ranges from 0.002% to 0.28%, according to a series of postmortem examinations reported by McAllister et al. 1,2 Approximately 75% of cardiac tumours are benign, myxomas being the most common in adults, followed by lipomas, fibromas and teratomas, with the left atrium being the most common location. 3 Rhabdomyomas represent the most frequent primary cardiac tumours in infancy and are associated with phakomatoses such as tuberous sclerosis. 4 However, metastases spreading from malignant melanomas and lymphomas are the most common aetiology of heart tumours.Cardiac lipomas account for 8.4% of primary tumours of the heart and pericardium. 1,2 According to the literature, 25% of cardiac lipomas are intramyocardial, 25% are extracavitary of epicardial origin and 50% are intracavitary of subendocardial origin; those of the right atrium are extremely rare. 5,6 Case HistoryA 71-year-old Caucasian woman presented to the emergency department with acute exacerbation of a 2-year history of recurrent dyspnoea and a new onset manifestation of hypertensive crisis. She did not complain of angina. Her past medical history included essential hypertension, dyslipidaemia, diabetes mellitus type 2 and obesity. Her past surgical history was significant for strumectomy in 1991 and tonsillectomy in early childhood. On physical examination, Kussmaul's sign was detectable on inspiration, suggestive of an increased jugular venous pressure. Laboratory analysis and tumour biomarkers were within normal ranges except for an elevated D-dimer. Chest x-rays revealed no signs of cardiomegaly or pulmonary oedema. The electrocardiography showed a sinus rhythm with premature atrial complexes and T wave abnormalities from lead V 4 to lead V 6 .Transoesophageal echocardiography revealed a large 5.5cm mass located in the right atrium extending along the free right atrial wall, severely impairing blood flow from the superior vena cava into and through the...