A rare case of a intracardiac lipoma

Abstract

Introduction: Primary tumors of the heart are exceedingly rare, accounting for less than 5% of all cardiac tumors; the remaining 95% of tumors are metastatic tumors to the heart. The most common primary cardiac tumors in adults are myxomas (usually occurring in the left atrium) followed by papillary fibroelastomas and lipomas with rhabdomyoma the most common in children.

Presentation of case: We are presenting a case of a 74-years-old female who initially presents with dizziness. No other associated symptoms reported and initial labs were in normal range. Echocardiogram was done as part of the dizziness/syncope work up which demonstrated a large right atrial mass. Due to the size of the mass and patient being symptomatic the mass was surgically resected with complete resolution of her symptoms and pathology consistent with a lipoma.

Discussion: Cardiac lipomas are benign and may be associated with a spectrum of symptoms which depends upon the size and location of the lipoma; although most cardiac lipomas are found incidentally and are asymptomatic. The best radiologic study to identify and help differentiate cardiac lipoma is echocardiogram. Cardiac computerized tomography (CCT) and cardiac magnetic resonance imaging (CMR) also place a role in differentiating cardiac lipomas from other cardiac tumors/lesions.

Conclusion: Cardiac lipomas are benign primary tumors which have no defined age or sex distribution and present with a wide range of symptoms. Echocardiography is first line diagnosis method with CCT/CMR for better imaging before surgical intervention. Surgical resection of the symptomatic cardiac lipomas remains the mainstream treatment.

Fig. 1

A: transthoracic echocardiogram (TTE): showing a mobile mass in right atria. B: transesophageal echocardiogram (TEE) shows mass in right atria. C: transesophageal echocardiogram (TEE) image of the R atrial mass and with approximate size. D: transthoracic echocardiogram (TTE) 1 year post surgery.

Fig. 2

A: pathology slide showing normal cardiac tissue on left lower side and lipoma on right upper stained with hematoxylin and eosin (H and E) at 100 magnification. B: high-1000 magnification of boundary of normal cardiac and lipoma tissue.