Report of a giant invasive, wall-penetrating cardiac lipoma

Abstract

Background: Cardiac lipoma, a seldom-encountered benign tumor positioned beneath the endocardium, has the potential to impair electrophysiological functions. Diagnosis is principally based on imaging modalities. The uniqueness of this case lies in the tumor's extension both internally and externally within the right atrium, rendering it of special interest. From a clinical standpoint, surgical removal is commonly advocated, wherein early intervention is pivotal in improving patients' long-term prognoses.

Case presentation: A 35-year-old male was admitted to the hospital for treatment subsequent to the identification of a cardiac mass two days prior. Initial diagnostic assessments, encompassing CT scans and echocardiography, identified a space-occupying lesion within the heart. The patient underwent surgical excision of the cardiac tumor, utilizing mild hypothermic extracorporeal circulation via femoral vessel access. Intraoperative findings revealed adipose-like tissue of a "dumbbell-shaped" configuration situated both within and external to the right atrium, measuring approximately 8 cm*9 cm internally and 7 cm*6 cm externally, with the extracardiac mass being marginally larger. Postoperative pathological analysis confirmed a cardiac lipoma diagnosis. A follow-up echocardiogram conducted three months post-surgery exhibited no notable abnormalities. The patient is under continuous observation to monitor for any recurrence or potential long-term complications.

Conclusion: In this case report, we detail with precision a rare cardiac pathology manifested by an expansive infiltrative lipoma that pervades the endocardial and epicardial layers of the right atrium. After thorough preoperative diagnostic workup and evaluation, we contend that surgical intervention represents the optimal therapeutic approach for managing such conditions, with the goal of preemptively reducing the likelihood of cardiac compression or intracardiac obstruction.

Keywords: Cardiac tumors; Cardiovascular surgery; Invasive cardiac lipoma; Right atrium tumor.

Fig. 1

Cardiac Lipoma Images A: Preoperative CT (the lesion indicated by the red arrow); B: Preoperative echocardiogram (an occupant in the right atrium indicated by the red arrow); C: Postoperative echocardiogram; D: Atrial mass observed during surgery (indicated by the red arrow); E: The entire specimen after excision (the extracardiac portion: red arrow; the intracardiac portion blue arrow); F: The tissue at the junction between the intracardiac and extracardiac portions of the mass; G, H, I: Pathological staining of the tumor sections (H&E 40x)