Incidental Finding of a Cardiac Mass on Abdominal CT Scan

A 21-year-old woman presented to our hospital with symptoms of nausea, vomiting, abdominal pain, and fever. She underwent abdominal computed tomography (CT) to evaluate the abdominal pain, and a mass was discovered incidentally at the left ventricular cardiac apex. She denied any cardiac symptoms.

Further evaluation through cardiac magnetic resonance imaging (CMR) showed a large, well-encapsulated intramuscular mass in the left ventricle apex measuring up to 2 cm × 3 cm (Figures A, B). Tissue characterization revealed that the mass was isointense to myocardium on T1-weighted images (Figure C) and hypointense on T2-weighted images (Figure D). On late gadolinium-enhanced (LGE) images, there was marked hyperenhancement, which was characteristic of a cardiac fibroma (Figures E, F).

Cardiac fibromas are benign primary tumors composed of fibroblasts and a large amount of collagen. These uncommon tumors are primarily found in the pediatric population, and their prevalence among adults is rare.1,2 Mainly located in the ventricular septum or left ventricular wall (intramural),3 these tumors have much extracellular space for gadolinium accumulation, resulting in intense enhancement on CMR LGE images. A cardiac fibroma may lead to congestive heart failure or invade conduction tissue and cause ventricular arrhythmias.4 Surgical resection is indicated in symptomatic patients.

Our patient remains asymptomatic and is monitored closely for symptoms. Repeat CMR imaging at 6 months demonstrated no change of the mass, suggesting that the lesion is benign.