From pathogenesis to treatment, a systemic review of cardiac lipoma

Abstract

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.

Keywords: Cardiac lipoma; Clinical management; Noninvasive diagnosis; Systemic review.

Fig. 1

Age and sex distribution of cardiac lipomas of 255 reported cases

Fig. 2

Site distribution of cardiac lipomas across heart and pericardium of 255 reported cases. LV: left ventricle; RA: right atrium; RV: right ventricle; LA: left atrium

Fig. 3

Clinical manifestations of 255 patients with cardiac lipomas

Fig. 4

Comparison of size between intracardiac, intramyocardial and intrapericardial lipomas

Fig. 5

CT and MR images of left ventricular (triangular arrows) and pericardial (asterisk) lipomas. Imaging features of cardiac lipomas show consistence with subcutaneous fat in all sequences