Atypical Presentation of a Cardiac Lipoma
DOI:
https://doi.org/10.59958/hsf.7375Keywords:
cardiac tumor, lipoma, atrial myxoma, lipomatous hypertrophy, echocardiography, MRI, cardiac CTAbstract
Cardiac masses can have atypical presentations and diagnosis can be difficult because of limitations in imaging modalities. We report the case of a 69-year-old man with a history of hypertension and hyperlipidemia who presented with several months of dyspnea with exertion. There was a soft systolic murmur on exam. Transthoracic echocardiogram showed a large right atrial mass that appeared to be adherent to the interatrial septum. Considering the size and apparent attachment to the interatrial septum the suspicion was a myxoma. After further imaging however, including transesophageal echocardiogram, cardiac computed tomography (CT) and cardiac magnetic resonance imaging (MRI) the diagnosis changed to a lipoma. The patient had surgical resection of the mass which confirmed the diagnosis. A multi-imaging approach may be helpful and required to accurately diagnose cardiac masses.
References
Tyebally S, Chen D, Bhattacharyya S, Mughrabi A, Hussain Z, Manisty C, et al. Cardiac Tumors: JACC CardioOncology State-of-the-Art Review. JACC. CardioOncology. 2020; 2: 293–311.
Naseerullah FS, Javaiya H, Murthy A. Cardiac Lipoma: An Uncharacteristically Large Intra-Atrial Mass Causing Symptoms. Case Reports in Cardiology. 2018; 2018: 3531982.
Wang H, Hu J, Sun X, Wang P, Du Z. An asymptomatic right atrial intramyocardial lipoma: a management dilemma. World Journal of Surgical Oncology. 2015; 13: 20.
Wu S, Teng P, Zhou Y, Ni Y. A rare case report of giant epicardial lipoma compressing the right atrium with septal enhancement. Journal of Cardiothoracic Surgery. 2015; 10: 150.
Nadra I, Dawson D, Schmitz SA, Punjabi PP, Nihoyannopoulos P. Lipomatous hypertrophy of the interatrial septum: a commonly misdiagnosed mass often leading to unnecessary cardiac surgery. Heart. 2004; 90: e66.
Gopal DJ, Han Y, Silvestry FE, Ferrari VA. Atypical presentation of lipomatous hypertrophy of the interatrial septum: a case report. European Heart Journal. Case Reports. 2019; 3: 1–4.
Shu S, Wang J, Zheng C. From pathogenesis to treatment, a systemic review of cardiac lipoma. Journal of Cardiothoracic Surgery. 2021; 16: 1.
Ucak A, Inan K, Onan B, Yilmaz AT. Resection of intrapericardial hibernoma associated with constrictive pericarditis. Interactive Cardiovascular and Thoracic Surgery. 2009; 9: 717–719.
Bagwan IN, Sheppard MN. Cardiac lipoma causing sudden cardiac death. European Journal of Cardio-Thoracic Surgery. 2009; 35: 727.
Zatorska K, Michalowska I, Duchnowski P, Szymanski P, Kusmierczyk M, Hryniewiecki T. The Usefulness of Magnetic Resonance Imaging in the Diagnosis of Infectious Endocarditis. The Journal of Heart Valve Disease. 2015; 24: 767–775.