A 64-Year-Old Woman with Imaging Features Consistent with a Posterior Intrapericardial Lipoma and 5-Year Imaging Follow-Up

Abstract

Patient: Female, 64-year-old Final Diagnosis: Intrapericardial lipoma Symptoms: No symptoms Medication:— Clinical Procedure: — Specialty: Cardiology Objective: Rare disease Background: Primary cardiac and pericardial neoplasms are rare and may be found incidentally on echocardiography. We present a case of a 5-year imaging follow-up in a patient with a large posterior pericardial lipoma diagnosed by magnetic resonance imaging of the mediastinum. Case Report: A 64-year-old woman was admitted to the Department of Cardiology for detailed assessment due to an intrapericardial mass revealed on transthoracic echocardiography in an outpatient setting. Computed tomography revealed a capsulated posterior intrapericardial homogenous mass of fat density. There was no enhancement of the lesion with contrast agent administration. Ultimately, magnetic resonance imaging confirmed the benign nature of the tumor, leading to the intrapericardial mass being classified as a lipoma. Due to the clinical features of the lesion – the preserved intracardiac flow and the asymptomatic course of the disease – conservative treatment was appropriate for this patient. A 5-year imaging follow-up was uneventful, the patient remained asymptomatic, a mild tumor growth was identified by computed tomography, and there was still no recommendation for surgery. Conclusions: This case has shown that although echocardiography and computed tomography imaging can identify posterior intrapericardial tumors, magnetic resonance imaging can identify diagnostic features and support the benign nature of a tumor that may not be amenable to surgical removal.

Hallazgos por imagen de lipoma pericárdico. Revisión de la literatura

“…A pesar de que los lipomas pericárdicos con frecuencia son masas encapsuladas de bordes definidos que no invaden estructuras adyacentes, la TAC permite identificar la extensión, desplazamiento y compresión de estructuras mediastinales como los bronquios fuente, tráquea, vena cava superior, arteria y venas pulmonares (17,22,23,51,52,56).…”

“…La mayoría de las descripciones de los reportes de caso se limitan a estas secuencias. Sin embargo, otros autores enfatizan la importancia de la caída de la señal de la grasa en secuencias con saturación como un hallazgo necesario para su confirmación (11,13,27,43,51).…”

Presentation and treatment of two massive intrapericardial lipoma. Case report

“…Primary pericardial tumors are very rare with an overall incidence of 0.001–0.007 % and account for approximately 10 % of cardiac neoplasms [ 1 ]. The most common benign pericardial tumors are intrapericardial lipomas (accounting for 8.4 % [ 2 ]), pericardial cysts, and hemangiomas [ 3 , 4 ]. Lipomas are benign soft tissue tumors consisting of mature fat cells often surrounded by a fibrous capsule [ 2 ].…”

Asymptomatic Caseous Calcification of the Mitral Annulus in a 66-Year-Old Woman with 3-Year Imaging Follow-Up

“…CCMA requires differentiation from other cardiac masses such as tumors (including myxoma, lipoma, hemangioma, or leiomyosarcoma), vegetations, and abscesses [ 2 , 7 ]. The clinical context is relevant to make the correct diagnosis.…”

“…On computed tomography (CT) scans, lipomas are homogeneous lesions with well-characterized margins and attenuation values ranging between −30 and −100 HU, with no contrast-enhanced areas. On magnetic resonance imaging (MRI), lipomas are homogenous masses with hyper-intense signal intensity on both T1- and T2-weighted images [ 7 ]. Other cardiac neoplasms have characteristic imaging features as well, but the detailed description of these is beyond the scope of this case report.…”