Anterior thalamic infarction as initial manifestation of a right atrial lipoma

From pathogenesis to treatment, a systemic review of cardiac lipoma

Cardiac lipoma is an uncommon primary cardiac tumor. With the advancement of diagnostic methods and treatment techniques, more cases of cardiac lipomas have been reported and suggest that the entity previously widely thought to display classic features may also show atypical findings. A systemic review of the rare cardiac tumor was done by searching the literature of cardiac lipoma. We endeavor to summarize the clinical features of the rare disease from pathogenesis to treatment. Literature of cardiac lipoma was retrospectively searched through PubMed and 255 cases of cardiac lipoma were included into this analysis. Cardiac lipomas can occur anywhere within the heart, 53.1% were located within the cardiac chambers, 32.5% in the pericardium, 10,7% within the myocardium and 3.7% involved multiple structures. More than half of the reported cardiac lipomas (66%) may be clinically symptomatic, presenting with symptoms ranging from chest discomfort to syncope depending on their size and location as well as extent of myocardial involvement. Noninvasive cardiac imaging has replaced the role of autopsy and cardiothoracic surgery in detection and diagnosis of cardiac lipomas. Most symptomatic patients (83.7%) were treated by resection of cardiac lipomas and 68.3% of asymptomatic patients also underwentprophylactic resection. Overgrowth and myocardial infiltration of lipomas may result in unsuccessful resection. Recurrence of cardiac lipomas was rare but reported in a few cases. The early detection and accurate diagnosis of cardiac lipoma is of great significance in clinical management, to avoid an unfavourable outcome due to overgrowth.

Ischemic stroke and incidental finding of a right atrial lipoma

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.