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

Surgical resection of a lipoma of the right atrium: A case report

RATIONALE

Cardiac tumors are relatively rare, with an incidence rate of 0.17% to 0.19% according to autopsy reports. The tumors may be detected through transthoracic echocardiography, computed tomography (CT), magnetic resonance imaging (MRI), and other examinations. The treatment plan is determined based on the nature of the tumor.

PATIENT CONCERNS

In this article, we report a case of a 61-year-old male who was found to have an occupying lesion in the right atrium and superior vena cava during a cardiac ultrasound examination.

DIAGNOSES

Enhanced CT and MRI suggested the possibility of a lipoma during admission.

INTERVENTIONS

The patient underwent video-assisted thoracoscopic cardiac tumor resection under extracorporeal circulation. The postoperative pathology was consistent with lipoma.

OUTCOMES

The recurrence rate after cardiac lipoma excision is low, and the prognosis is generally good. However, for patients with cardiac lipomas involving ventricles and myocardial infiltration, intraoperative excision is more challenging, and the long-term outcome is poor.

LESSONS

Cardiac lipomas are generally asymptomatic even in large dimensions. Echocardiograms can identify tumors, but cardiac MRI or cardiac CT can differentiate cardiac lipomas from other cardiac tumors.

Cardiac Computed Tomography as a Method of Diagnosing the Type of Cardiac Tumor-Example of Interatrial Septal Lipoma Filling the Right Atrium

Cardiac tumors present substantial diagnostic challenges due to their diverse manifestations and similarity to other cardiac pathologies. Cardiac lipomas are rare tumors that originate from adipose cells and can develop in any location within the heart. Cardiac lipomas account for 2.4% of all primary cardiac tumors. Most lipomas are located within the cardiac chambers. Among the lipomas occurring within the cardiac chambers, the most common localization is the right atrium. Currently, the gold standard for imaging cardiac tumors is cardiac magnetic resonance (CMR). Despite the significant advantages of CMR, cardiac computed tomography angiography (CCTA) continues to be a valuable technique when CMR is either unavailable or contraindicated. In some cardiac tumors, CCTA can identify the type of tumor. A classic example of this type is a lipoma. We present images of a large interatrial septal lipoma filling the right atrium diagnosed by CCTA in a 57-year-old female Caucasian patient. In summary, CCTA effectively identifies lipomas' characteristic features and provides crucial information for appropriate management.

A Cadaveric Case Report of a Rare Atrial Septal Lipoma

Primary cardiac tumors (PCTs) are rare and include myxomas, papillary fibroelastomas, rhabdomyomas, and lipomas. Lipomatous hypertrophy of the atrial septum (LHAS) is a benign condition associated with aging and obesity that is marked by fat accumulation in the interatrial septum and is caused by hyperplasia of adipose cells. In contrast, lipomas are characterized as soft masses of fat that are encapsulated by thin, fibrous tissue. True cardiac lipomas are rare and can present a diagnostic dilemma. Cardiac lipomas are generally asymptomatic but may present with angina, dyspnea, or syncope. Less frequently, they can cause arrhythmias, valve dysfunction, or emboli. Diagnosis generally requires cardiac MRI or alternate imaging modality. In this report, we present a case of a true atrial septal lipoma with a sessile base protruding into the right atrium discovered during the pedagogic dissection assignment of the interior of the heart. The tumor measured 0.5 × 1.0 cm, and on the cut surface, it appeared yellow and encapsulated. Histopathological examination of the lipomatous mass revealed extensive nodular thickening of the interatrial septum from the accumulation of mature adipose tissue reaching the resection surface. It is possible that the lipoma may have had a space-occupying effect, which would have increased the volume within the right atrium and had an adverse effect on tricuspid valve function. This is consistent with the dilated and thin-walled appearance of the right atrium. This report contributes to the limited literature on this type of benign, primary cardiac tumor and provides a clear illustration and clinical relevance to showcase the pathology and its possible clinical consequences.

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.

Successful Removal of a Posterior Cardiac Lipoma by Transection of the Ascending Aorta and Main Pulmonary Artery

Primary cardiac tumors are unusual, whereas lipomas are particularly rare. We successfully removed a very large posterior cardiac lipoma by transecting the ascending aorta and main pulmonary artery. Transecting both the ascending aorta and the main pulmonary artery facilitated surgical exposure and complete removal of the posterior cardiac lipoma.

Multiple lipomata of the tricuspid valve and papillary muscle: case report

Background

Cardiac lipomas are rare benign primary tumours of the heart. Due to the nature of these tumours, they are often asymptomatic and diagnosed incidentally. Whether asymptomatic patients with cardiac lipomas should perform surgery still remains controversial.

Case summary

A 34-year-old Asian male who was incidentally found hyperechoic masses in the right ventricle (RV) on the transthoracic echocardiogram by annually routine physical examination was admitted to our cardiology department. His medical history was unremarkable. The repeated transthoracic and transoesophageal echocardiogram showed multiple solitary and well-demarcated masses in the RV. On the cardiac magnetic resonance imaging, four discrete masses (considering the possibility of it being a lipoma) partially occluding the right ventricular outflow tract (RVOT) were observed. During the open-heart resection surgery, it was found that the tricuspid valve and papillary muscle were covered by multiple adipose masses in the RV that arose from the interventricular septum and the free wall, resulting in partial RVOT obstruction. These excised masses were histopathologically confirmed as lipomata characterized by the mature adipocytes with entrapped myocardial cells. The patient had no cardiac abnormality in the 1-month follow-up after the surgery.

Discussion

This rare clinical case of multiple lipomata of the tricuspid valve and papillary muscle acknowledges that multimodality imaging is the cornerstone for the assessment and diagnosis. Surgery should be performed in cases of symptomatic or large lipomas as well as when a lipoma is considered to be high risk because of RVOT obstruction.

Side-to-side esophagogastric anastomosis for minimally invasive Ivor-Lewis esophagectomy: operative technique and short-term outcomes

Totally minimally invasive Ivor-Lewis esophagectomy (TMIIL) is associated to lower rate of post-operative complication, decreases length of hospital stay and improves quality of life compared to open approach. Nevertheless, adaptation of TMIIL still proceeds at slow pace, mainly due to the difficulty to perform the intra-thoracic anastomosis and heterogeneity of surgical techniques. We present our experience with TMIIL utilizing a stapled side-to-side anastomosis. We retrospectively evaluated 36 patients who underwent a planned TMIIL from January 2017 to September 2020. Esophagogastric anastomoses were performed using a 3-cm linear-stapled side-to-side technique. General features, operative techniques, pathology data and short-term outcomes were analyzed. The median operative time was 365 min (ranging from 240 to 480 min) with a median blood loss of 100 ml (50–1000 ml). The median overall length of stay was 13 (7–64) days and in-hospital mortality rate was 2.8%. Two patients (5.6%) had an anastomotic leak, without need for operative intervention and another patient developed an anastomotic stricture, resolved with a single endoscopic dilation. Chylothorax occurred in three patients; two of these required a surgical intervention. Pulmonary complications occurred in six patients (16.7%). Based on Comprehensive Complications Index (CCI), median values of complications were 27.9 (ranging from 20.9 to 100). The results of our study suggest that TMIIL with a 3-cm linear-stapled anastomosis seems to be safe and effective, with low rates of post-operative anastomotic leak and stricture.

Giant right ventricle infiltrative lipoma-a surgical success report

Benign primary cardiac tumours are rare, with lipomas accounting for <9% of them. Their presentation varies depending on the size and location of the tumour, with the majority of the cases being asymptomatic. We are presenting a case of an extremely rare primary heart-tumour infiltrating the right ventricle (RV) compromising its function. RV lipomas are so unusual that there are no clear treatment guidelines. In this case, we decided to treat the patient with surgical resection of the tumour. Although a total resection was not possible, due to the tumoural proximity to vital structures, a great portion of the tumour was removed, alleviating the patient's symptoms.

Diaphragmatic Lipoma in a Woman with Rheumatoid Arthritis: A Case Report and Literature Review

Patient: Female, 52-year-old

Final Diagnosis: Diaphragmatic lipoma

Symptoms: Shortness of breath

Medication: —

Clinical Procedure: CT scan

Specialty: Radiology • Rheumatology

Incidental discovery of right ventricular lipoma in a young female associated with ventricular hyperexcitability: An imaging multimodality approach

BACKGROUND

Cardiac lipomas are rare benign tumors commonly found in the right atrium or left ventricle. Patients are usually asymptomatic, and clinical presentation depends on location and adjacent structures impairment. Right ventricle lipomas are scarce in the literature. Moreover, the previous published cases were reported in over 18-year-old patients.

CASE SUMMARY

We report a giant right ventricle lipoma discovered incidentally in a 17-year-old female while performing preoperative work-up. The diagnosis was confirmed by histopathological examination, and a conservative approach was performed.

CONCLUSION

Multimodal cardiac imaging and histopathological examination are required for a definitive diagnosis. The therapeutic approach depends on clinical presentation.

Giant Pericardial Lipoma Inducing Cardiac Tamponade and New Onset Atrial Flutter

Although pericardial lipomas are both rare and benign, rapid or excessive growth can induce potentially fatal conditions such as pericarditis, arrhythmia, and cardiac tamponade. This case illustrates an example where a 65-year-old with atypical chest tightness unveiled a 10 × 15 cm anterior pericardial mass with circumferential effusion and progressive deterioration to cardiac tamponade. Initial transthoracic echocardiogram imaging was technically difficult in this patient due to habitus and body mass, which failed to illustrate underlying effusion. Recurrent bouts of refractory supraventricular tachycardia prompted further investigation of this patient's presentation with transesophageal echocardiogram, which showed evidence of an echogenic mass with cardiac tamponade. An urgent pericardial window and pericardial lipectomy immediately relieved this hemodynamically compromising condition. Subsequent atrial flutter resulted with the removal of the anterior fat pad during surgery, complicating recovery.

A right atrial fat ball: Rare case of cardiac lipoma

Due to varied presentation, a high index of suspicion is needed for diagnosis of cardiac lipoma. Treatment should only be reserved for symptomatic patients. This case acknowledges the importance of cardiac MRI in making the diagnosis of cardiac lipoma and further delineating the management options available.

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.

Cardiac Lipoma: An Uncharacteristically Large Intra-Atrial Mass Causing Symptoms

Primary tumours of the heart are often encountered in clinical practice. Different autopsy series estimate the incidence to be anywhere from 0.001% to 0.19%. Cardiac lipoma is a rare type of tumour of the heart and pericardium. It comprises approximately 10–19% of all cardiac tumours. We present a case of a large cardiac lipoma in a fifty-year-old female. She presented with sharp chest pains, palpitations, and dizziness. Acute coronary syndrome was ruled out. A transthoracic echocardiogram showed an abnormal, large, fixed right atrial mass. The mass was noted to be occupying most of the right atrium. It was excised due to its large size and persistent symptoms. On pathophysiology, the mass was definitively diagnosed to be an 80 mm × 70 mm cardiac lipoma. Postoperatively, the patient did well with resolution of her symptoms. This case provides evidence that even large, invasive, symptomatic cardiac lipomas can be successfully resected with good outcomes.

Neoplastic Pericardial Disease

Pericardial tumors are rare lesions that include a range of neoplastic conditions that may arise within the pericardium or metastasize to involve it secondarily. Understanding the spectrum of lesions that are included in the differential diagnosis of a pericardial mass-lesion is critical to making timely, accurate diagnoses and getting the appropriate therapy should one be necessary. This review summarizes the radiologic and pathologic findings of the most commonly encountered of these entities.

Invasive Cardiac Lipoma: a case report and review of literature

Background

Cardiac lipomas are rare benign tumors of the heart. They are usually asymptomatic and are thus most often diagnosed on autopsies. Symptoms, when present, depend upon the location within the heart. Typical locations are the endocardium of the right atrium and the left ventricle. Diagnostic modality of choice is cardiac MRI. Treatment guidelines have not yet been established due to the very low prevalence of these tumors and are thus guided by the patient’s symptomatology.

Case presentation

We describe a case of an invasive cardiac lipoma, wherein the initial symptom of the patient was shortness of breath. Although the echocardiogram visualized the tumor in the right atrium, a cardiac MRI was performed for better tissue characterization. The MRI revealed a large, fat containing, septated mass in the right atrium with invasion into the inter-atrial septum and inferior cavoatrial junction. There was also invasion of the coronary sinus along the inferior and left lateral aspect of the posterior atrioventricular groove. Although the mass appeared to represent a lipoma by imaging characteristics, the unusual extension into the coronary sinus led to consideration of a low-grade liposarcoma in the differential. Thus a pre-operative biopsy was performed along with MDM2 gene amplification to rule out a liposarcoma preceding surgical excision.

Conclusion

Cardiac lipomas are well-characterized on cardiac MRI, which is the diagnostic modality of choice. Typical locations are the right atrium and the left ventricle. However, in those with atypical features such as invasion of the coronary sinus, pre-operative biopsy for histopathologic confirmation is imperative to exclude well-differentiated liposarcoma. Our patient with a simple lipoma underwent partial resection to relieve symptoms. We discuss prognosis and treatment of symptomatic cardiac lipomas.