A 42-year-old woman presented with a 6-month history of progressively reduced exercise tolerance. Clinical examination revealed displaced apex beat. There was no pleural effusion, pedal edema, or distention of the jugular vein.
Transthoracic echocardiogram and images from contrast-enhanced cardiac CT and MRI revealed a large mass in the left ventricle with global left ventricular hypokinesia and an ejection fraction of 40% (Figs 1, 2). The mass was surgically resected, and histopathologic findings revealed intraventricular lipoma. The patient was asymptomatic at 1-year follow-up.
Figure 1:
(A) Color Doppler mode transthoracic echocardiogram shows a large hyperechoic mass (*) measuring 20.4 cm2, occupying almost half of the left ventricular (LV) cavity. (B) Cardiac CT angiogram demonstrates dilated LV with a large, nonenhancing fat-attenuation mass (*) measuring 6.6 × 5.7 × 5.3 cm and with an attenuation of −110 to −87 HU. The mass is multilobulated, with blood pool contrast agent insinuated in between the lobulations (arrows). No foci of calcification or necrotic component are seen. RV = right ventricle.
Figure 2:
Cardiac MR images. (A) Static four-chamber view of steady-state free precession (SSFP) image shows a well-encapsulated multilobulated hyperintense mass (*) within the dilated left ventricle (LV). The LV septum is thinned due to diffuse LV dilatation. The mass exhibits hyperintense signals on both (B) T1-weighted and (C) T2-weighted images and hypointense signal on short inversion time inversion recovery (STIR) images, similar to fat. (D) There is no perfusion in the early postgadolinium sequence. (E) The mass does not enhance at delayed postgadolinium sequence. (F) No evidence of myocardial infiltration. No pericardial effusion. Other cardiac chambers are unremarkable. LA = left atrium, RA = right atrium, RV = right ventricle.
Cardiac lipomas are rare benign primary tumors of the heart (1). Most patients are asymptomatic, but large lipomas may cause varying symptoms, from mild discomfort to syncope, depending on the size and location of the mass (1). Multimodality imaging, particularly the use of MRI, plays an important role in accurate diagnosis and comprehensive evaluation (2). Cardiac lipomas appear as homogeneous, low-attenuation masses at CT (2). At MRI, they exhibit homogeneous signals similar to fat in all pulse sequences, including fat-suppression techniques. They do not enhance with the administration of contrast material (2). Management of cardiac lipoma is not standardized; however, consensus suggests all cardiac lipomas be resected (3).
Footnotes
Authors declared no funding for this work.
Disclosures of conflicts of interest: S.A.B. No relevant relationships. K.M. No relevant relationships.
Keywords: CT, Echocardiography, MR Imaging, Cardiac, Heart, Left Ventricle
References
- 1. D'Souza J , Shah R , Abbass A , Burt JR , Goud A , Dahagam C . Invasive cardiac lipoma: a case report and review of literature . BMC Cardiovasc Disord 2017. ; 17 ( 1 ): 28 . [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. Araoz PA , Mulvagh SL , Tazelaar HD , Julsrud PR , Breen JF . CT and MR imaging of benign primary cardiac neoplasms with echocardiographic correlation . RadioGraphics 2000. ; 20 ( 5 ): 1303 – 1319 . [DOI] [PubMed] [Google Scholar]
- 3. Shu S , Wang J , Zheng C . From pathogenesis to treatment, a systemic review of cardiac lipoma . J Cardiothorac Surg 2021. ; 16 ( 1 ): 1 . [DOI] [PMC free article] [PubMed] [Google Scholar]