Invasive cardiac lipoma at the left ventricular intermuscular region: A case report

The present study described the case of a 22-year-old woman who had symptoms of left chest pain for >6 months, with further aggravation over 2 days. Computed tomography (CT) images of the mediastinal and pulmonary windows showed low-density shadows in the left ventricle. Echocardiography indicated a slightly stronger echo cluster in the left ventricle, with a range of ~29x30x35 mm, which was closely related to the lower wall and part of the posterior wall of the left ventricle. Contrast-enhanced ultrasound showed that the left ventricular mass was enhanced in a circular and dot-line shape, with a solid mass occupying the left ventricle and a rich blood supply. CT angiography revealed a nodule of size 27x27x24 mm in the left ventricle. During the operation, it was observed that the cardiac lipoma invaded the chordae tendinae and papillary muscle, and a valve replacement was performed. Postoperative examination revealed a piece of gray and anaplastic tissue, measuring 30x22x17 mm. The pathology of the specimen showed that the morphology of the left ventricular mass met the criteria of an intramuscular lipoma. The present study reported a cardiac lipoma involving the left anterior chordae tendinae and papillary muscle, with the patient showing only nonspecific symptoms. Early surgery should be applied to improve the prognosis of cardiac lipoma.

Surgical treatment of cardiac lipoma: 20 years' experience in a single center

BACKGROUND

Primary cardiac lipoma is very rare, and no consensus has been developed regarding its ideal treatment strategy. This study reviewed the surgical treatment of cardiac lipomas in 20 patients over 20 years.

METHODS

Twenty patients with cardiac lipomas were treated at Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College from January 1, 2002, to January 1, 2022. The patients' clinical data and pathological reports were retrospectively analyzed, and the follow-up with a range of 1 year to 20 years was conducted.

RESULTS

The cardiac lipomas were located in the right atrium (RA) or superior vena cava (SVC) in seven patients (35%) (RA in six patients and SVC in one patient), left ventricle in eight patients (40%) (left ventricular chamber in four patients and left ventricular subepicardium and myocardium in four patients), right ventricle in three patients (15%) (right ventricular chamber in one patient and right ventricular subepicardial layer and myocardium in two patients), subepicardial interventricular groove in one patient (5%), and pericardium in one patient (5%). Complete resection was achieved in 14 patients (70%), including seven patients with lipomas in the RA or SVC. Incomplete resection occurred in six patients (30%) with lipomas in the ventricles. No perioperative deaths occurred. Long-term follow-up was conducted for 19 patients (95%), including two (10%) who died. Both patients who died had lipomas incompletely resected due to ventricles involvement, and preoperative malignant arrhythmias persisted post-operatively.

CONCLUSIONS

The complete resection rate was high, and the long-term prognosis was satisfactory in patients with cardiac lipomas that did not involve the ventricle. The complete resection rate was low in patients with cardiac lipomas in ventricles; and complications, including malignant arrhythmia, were common. Failure of complete resection and post-operative ventricular arrhythmia are correlated with post-operative mortality.

A rare case of cardiac tumor of the interventricular septum complicated with atrioventricular block

Lipomatous hypertrophy of the interatrial septum is a rare benign condition characterized by adipocyte hyperplasia with fat infiltration between the myocardial fibers in the interatrial septum. Although lipomatous hypertrophy does not occur only in the interatrial septum, its location in the interventricular septum is extremely rare. A 45-year-old woman with no medical or family history of cardiac disease presented with an episode of syncope. Transthoracic echocardiography revealed an echogenic mass in the interventricular septum and no outflow obstruction. The mass-like area showed fat tissue-specific features on computed tomography and magnetic resonance imaging, and furthermore, it showed late gadolinium enhancement. We diagnosed it as lipomatous hypertrophy of the interventricular septum. An implantable loop recorder documented paroxysmal complete atrioventricular block with presyncope. A permanent dual-chamber pacemaker was implanted. This is the first reported case of lipomatous hypertrophy of the interventricular septum treated with a pacemaker for complete atrioventricular block with syncope. We have described the case and the treatment strategy in detail.

Learning objective

To understand lipomatous hypertrophy, a rare disorder, and its characteristics and differences between lipomatous hypertrophy and cardiac adipose tumors on computed tomography and magnetic resonance imaging. To learn about the appropriate treatment and clinical management of this benign condition and treat symptomatic patients.

Antreou A, A. Karvounaris S. Lipomatous Hypertrophy of the Interatrial Septum in a Patient with Chronic Dyspnea and Episodes of Paroxysmal Atrial Fibrillation: A Case Report

Lipomatous Hypertrophy of the Interatrial Septum (LHIS) is an unusual condition usually found as an incidental finding on echocardiography. It can create a mass-like bulge typically sparing the fossa ovalis. We describe a 73-year-old overweight Cypriot woman, who visited our clinic in November 2018 and was complaining of dyspnea on exertion, chest tightness, and two episodes of paroxysmal atrial fibrillation for the last eight months. A big sessile mass was detected in the interatrial septum measuring 3.7×4.7 cm during transoesophageal echocardiography. The patient underwent resection of the mass and pericardial patch reconstruction of the defect with significant improvement of her clinical status during the follow-up period. The histopathological analysis suggested LHIS. In patients with persistent cardiac symptoms, a prompt resection is a useful option, although surgery is generally considered unnecessary in this clinical setting. Preprint of this article is available on: https://www.authorea.com/users/380290/articles/496351-a-patient-with-chronic-dyspnea-and-episodes-of-paroxysmal-atrial-fibrillation-in-the-presence-of-a-right-atrial-mass.

Surgical Management for a Rare Pedunculated Left Ventricular Apical Lipoma: A Case Report and Review of Literature

Cardiac lipomas, though extremely rare, are encapsulated tumors composed primarily of mature fat cells. Despite their benign character, cardiac lipomas can cause life-threatening complications by rapid growth. Cardiac lipomas, which are frequently located in the left ventricle (LV) or right atrium, can originate either from the subendocardium, subpericardium, or the myocardium. They are usually asymptomatic and carry a good prognosis during long-term follow-up; however, published reports show that untreated cardiac lipomas may be fatal when they cause arrhythmic or obstructive symptoms. In addition, several surgical options have been reported to obtain an appropriate operative view following poor visualization, primarily when tumors are located in the LV. Herein, we present a case of a pedunculated LV apical lipoma in a symptomatic patient successfully managed by surgical resection. We also discuss diagnostic modalities in surgical planning and the choice of surgical approach.

Cardiac Lipoma Extirpation with Chronic Lung Abscess Excision: A Case Report of Simultaneous Video-Assisted Thoracoscopic Surgery Procedures

This study examined a rarely seen benign heart tumor that was found incidentally on a chest X-ray. Radiological images were taken of a 42-year-old patient with no symptoms of a heart condition, showing a thick-walled left lung cavity that appeared after prior inflammation and concomitant enlargement of the cardiac shadow. A large subepicardial lipoma in combination with a chronic abscess on the left lung was revealed on chest computed tomography. The treatment consisted of simultaneous surgical removal of both the lung and heart lesions using video-assisted thoracoscopic surgery.

Lipomatous hypertrophy of the interventricular septum

BACKGROUND AND AIMS

Lipomatous hypertrophy of the interatrial septum is an uncommon type of cardiac adipose tumor. It is extremely rare for these lesions to be located in the interventricular septum.

METHODS

We report this case of incidentally diagnosed lipomatous hypertrophy of the interventricular septum with right ventricular outflow obstruction which caused minimal symptoms and Wolff-Parkinson-White pattern on EKG.

CONCLUSION

We also discuss the diagnosis and management of this condition.

"Left ventricular lipoma….. a rare case", case report

Background

A cardiac lipoma is a rare primary cardiac tumor. They are usually asymptomatic and carry a good prognosis. Cardiac Magnetic Resonance Imaging (CMR) is the confirmatory investigation of choice.

Case presentation

We present a case of left ventricular lipoma in an asymptomatic patient, which was successfully treated with surgical resection.

Conclusion

Cardiac lipomas are rare and are usually benign. There is no guideline on the management of cardiac lipomas and treatment is individualized.

Lipomatous hypertrophy of the interatrial septum is a pathologic, not an anatomic diagnosis

BACKGROUND AND AIM

Lipomatous hypertrophy of the interatrial septum (LHIS), a fatty tumor, is usually diagnosed on both echo and CT/MRI imaging. Cases of LHIS located outside of the interatrial septum are extremely rare and rarer still are these cases large enough to cause symptoms. The clinical literature demonstrates a misunderstanding that fatty tumors outside the intra-atrial area represent lipomas. However, pathologic understanding of these fatty tumors is clear and is based on microscopic findings.

METHODS

The tumor was removed by diving the base of attachment at the left ventricular apex via a median sternotomy on cardiopulmonary bypass.

RESULTS

The patient made an uneventful recovery and remains well at 6 months postoperatively.

CONCLUSIONS

On rare occasions, LHIS can arise from outside the interatrial septum. An LHIS can be differentiated from a lipoma by the presence of entrapped cardiac myocytes in LHIS, making it a pathological, rather than an anatomic, diagnosis.

Not-so-benign massive cardiac lipoma

Cardiac lipomas are rare and usually benign tumors that often remain asymptomatic throughout one's lifetime. We report a case of a 60-year-old man with a cardiac lipoma diagnosed early in childhood. However, due to the lack of surgical expertise in rural India, the lipoma was not removed. After moving to the United States, he received irregular follow-up with serial chest x-ray and computed tomography, which demonstrated an enlarging lipomatous mass occupying the pericardial space. After remaining asymptomatic for more than 37 years, he presented to the hospital with dyspnea. He underwent a surgical resection but, unfortunately, given the extension of the mass into multiple critical portions of the heart, he ultimately died.