Right atrial lipoma: A case report and literature review

Abstract

Cardiac lipomas are generally asymptomatic even in large dimensions. Echocardiograms can identify tumors, but cardiac magnetic resonance imaging or cardiac computerized tomography can differentiate cardiac lipomas from other cardiac tumors. The present study is a case report of an asymptomatic 30-year-old man diagnosed with atrial lipoma. The patient received cardiac surgery and the intervention consisted of exclusion of the right atrial (RA) tumor and reconstruction of the right atrium with 'XenoSure' patch in extracorporeal circulation through a minimally invasive approach. A short PubMed literature review was performed and 26 cases of RA lipomas with available details were found. Cardiac tumors may cause clinical presentation through different pathways. Symptoms related to an RA lipoma were present in 21 out of 26 patients (80%). The symptoms varied greatly, dyspnea being the most common of them. In one case, the lipoma was found during the autopsy of a patient after sudden death. Large cardiac lipomas can lead to complications such as obstruction of ventricular outflow tract, electric disorders, embolism or pericardial effusion. Obstruction of the right ventricular outflow tract was reported in 11 out of 26 patients (42%) diagnosed with RA lipoma. Generally, atrial lipoma can have various sizes. The most useful imaging technique was transthoracic echocardiography. Accurate diagnosis and evaluation of cardiac lipoma is dependent on multimodality imaging methods, including cardiac magnetic resonance. Surgery is the treatment of choice, but the risk-benefit ratio must be considered, and shared decision making must be taken into account. The present review data showed that 23 out of 25 patients (92%) underwent surgery. Among these patients, only 1 out of 23 received a minimally invasive approach in 2021. Cardiac lipomas are rare entities, usually asymptomatic, that can occur at any age. The most useful diagnostic method of cardiac tumors is echocardiography, but nuclear magnetic resonance can also specify the type and characteristics of tumors.

Cardiac lipoma in a young lady

“…Lipoma is a hypovascular non-enhancing tumor and sometimes may demonstrate septa. 7,8 Its treatment is resection in symptomatic cases, but in asymptomatic cases, the patient can be monitored without resection with serial imaging. If resection is performed, recurrence is rare, but close follow-up is still recommended.…”

“…To confirm the presence of fat in cardiac tumor, signal drop out on fat‐suppressed sequences can be used. Lipoma is a hypovascular non‐enhancing tumor and sometimes may demonstrate septa 7,8 …”

Lipoma Cardíaco como um Achado Incidental em Exame de Imagem Cardiovascular

“…Os sintomas variaram significativamente, sendo a dispneia a mais comum (35%), seguida de dor torácica (15%) e palpitações (12%). 6 Os lipomas são caracterizados como massas moles de tecido adiposo, frequentemente rodeadas por uma fina camada de tecido fibroso. Embora a maioria dos lipomas cardíacos sejam compostos de tecido adiposo branco maduro, foram relatados…”

“…Variações genéticas, principalmente envolvendo o gene HMGA2, são comumente observadas em lipomas extracardíacos. 6,7 Foram relatados múltiplos lipomas cardíacos em pacientes com esclerose tuberosa, embora sua relação ainda não tenha sido totalmente estabelecida. Atualmente não há evidências sugerindo que os lipomas cardíacos possam sofrer transformação maligna.…”

Cardiac lipoma in a young lady

“…Lipoma is a hypovascular non-enhancing tumour and sometimes may demonstrate septa. (6,7) Its treatment is resection in symptomatic cases, but in asymptomatic cases, the patient can be monitored without resection with serial imaging. If resection is performed, recurrence is rare, but close follow-up is still recommended.…”