Epicardial lipoma--a rare differential diagnosis in cardiovascular medicine

Epicardial Space: Comprehensive Anatomy and Spectrum of Disease

The epicardial space (ES) is the anatomic region located between the myocardium and the pericardium. This space includes the visceral pericardium and the epicardial fat that contains the epicardial coronary arteries, cardiac veins, lymphatic channels, and nerves. The epicardial fat represents the main component of the ES. This fat deposit has been a focus of research in recent years owing to its properties and relationship with coronary gossypiboma plaque and atrial fibrillation. Although this region is sometimes forgotten, a broad spectrum of lesions can be found in the ES and can be divided into neoplastic and nonneoplastic categories. Epicardial neoplastic lesions include lipoma, paraganglioma, metastases, angiosarcoma, and lymphoma. Epicardial nonneoplastic lesions encompass inflammatory infiltrative disorders, such as immunoglobulin G4-related disease and Erdheim-Chester disease, along with hydatidosis, abscesses, coronary abnormalities, pseudoaneurysms, hematoma, lipomatosis, and gossypiboma. Initial imaging of epicardial lesions may be performed with echocardiography, but CT and cardiac MRI are the best imaging modalities to help characterize epicardial lesions. Due to the nonspecific onset of signs and symptoms, the clinical history of a patient can play a crucial role in the diagnosis. A history of malignancy, multisystem diseases, prior trauma, myocardial infarction, or cardiac surgery can help narrow the differential diagnosis. The diagnostic approach to epicardial lesions should be made on the basis of the specific location, characteristic imaging features, and clinical background. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.

The characteristics of invasive cardiac lipoma: case report and literature review

Invasive cardiac lipoma is a rare type of primary cardiac tumor that is composed of adipose tissue but infiltrating the adjacent structures. It is a benign tumor that can cause significant morbidity and mortality due to its size and location within the heart. We describe a giant invasive intracardiac lipoma across atrial wall extending to the ascending aorta and the superior vena cava. This review will provide an overview of invasive cardiac lipoma, including its clinical presentation, diagnosis, and management.

A Rare Presentation of Cardiac Lipoma as an Acute Coronary Syndrome: A Case Report and Review of Literature

Cardiac lipomas are rare benign cardiac tumors that are seldom symptomatic. We present a case of a 49-year-old female who presented with one week of substernal chest pain and uncontrolled hypertension. Initial workup showed left ventricular hypertrophy with non-specific intraventricular delay and T wave inversion in leads I and aVL on electrocardiogram (EKG), troponinemia, and elevated brain natriuretic peptide levels. A transthoracic echocardiogram showed mildly reduced left ventricular ejection fraction and severe segmental hypokinesis of the left ventricle. The patient was admitted to the hospital as a case of non-ST elevation myocardial infarction (NSTEMI), and appropriate treatment was commenced. The patient underwent an urgent coronary angiogram that showed no significant epicardial coronary artery disease. Subsequently, a gadolinium-enhanced cardiac MRI (CMR) was performed to rule out underlying structural abnormalities, which demonstrated a well-demarcated cardiac mass involving the left ventricular wall with characteristic features of cardiac lipoma. The patient had a favorable prognosis with conservative management, and she was discharged home in stable condition with a close follow-up for repeat CMR.

Although more studies are required, we suggest that cardiac MRI should be considered in patients with NSTEMI and non-revealing coronary angiography to rule out underlying cardiac tumors such as cardiac lipoma.

Invasive cardiac lipoma diagnosis based on echocardiography: Case report and literature review

Echocardiography is first-line examination of cardiac tumors. We report the case of a 25-year-old woman with a right atrial transmural invasive lipoma, and we review 58 published reports of primary cardiac invasive lipomas detected by echocardiography. We summarize the ultrasonographic characteristics and main sites of development, and examine the "invagination hypothesis". Echocardiography appears valuable for early detection, intraoperative monitoring, and postoperative follow-up of invasive cardiac lipomas.

Voluminous Intrapericardial Lipoma Mimicking Pericardial Effusion

Lipomas are rare primary heart tumors and may involve the endocardium, myocardium, or pericardium. Signs and symptoms depend on the tumor location and size. The intrapericardial lipoma we report has massive dimensions and mimics a pericardial effusion. A 38-year-old male complained of dyspnea and precordial pain. On physical examination, heart sounds were diminished. The patient had received extensive medication for a clinically suspected pericardial effusion due to heart failure. A voluminous mass resembling fat within the pericardial sac was revealed by transesophageal echocardiography and a computed tomography scan. The tumor was removed successfully by a subxiphoid surgical approach. The diagnosis of a 635 gram intrapericardial lipoma was confirmed by pathological examination. After surgery, the patient recovered well and was completely asymptomatic at a follow-up at 90 days. No medications were being taken since. The diagnosis of a pericardial effusion should be secured by imaging exams to avoid unnecessary medications. Cardiac lipomas can be readily recognized by their typical features on radiologic imaging. The surgical pathology examination confirms the diagnosis and rules out malignancy criteria.

Multiple well-differentiated cardiac liposarcoma with a concomitant myocardial lipoma: A case report

A cardiac lipoma and a cardiac liposarcoma are very uncommon conditions; however, the simultaneous development of the two is extremely rare. In addition, the symptoms of these conditions are not evident in the vast majority of cases, making them easily missed during diagnosis. The present case report describes a case of well-differentiated cardiac liposarcoma with a concomitant myocardial lipoma that was misdiagnosed as multiple cardiac lipomas. The ultrasound, computed tomography, and magnetic resonance imaging presentations of the tumour were described. In addition, relevant literature regarding these two types of tumours was reviewed and compared in order to help improve the identification of these types of tumours. This, in turn, may be beneficial in the selection of more appropriate examination and treatment strategies.

A rare case report of giant epicardial lipoma compressing the right atrium with septal enhancement

Background

Cardiac Lipoma is a rare entity constituting approximately 10-19 % of primary tumors of the heart and pericardium. To our best knowledge, such a large cardiac lipoma with septal enhancement in our case has never been reported before.

Case presentation

Here we present a rare case of a 65-year-old symptomatic female with an unusual giant cardiac lipoma. Due to the enhancement of the tumor septa, it was first diagnosed as liposarcoma and thought to be unresectable. Debulking surgery was performed to release patient’s symptoms.

Conclusions

The patient ultimately underwent complete tumor resection with uneventful postoperative evolution. The postoperative pathological diagnosis is cardiac lipoma.