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      An asymptomatic right atrial intramyocardial lipoma: a management dilemma

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          Abstract

          Background

          The atrial intramyocardial lipomas are rare benign unusual tumors of the heart. The indication and best form of treatment for cardiac lipomas remain controversial.

          Case presentation

          The atrial intramyocardial lipomas are rare benign unusual tumors of the heart. We report a 55-year-old Chinese female with a history of hypertension. Echocardiography and 64-slice computed tomography showed a fatty mass in the right atrium. Although she was asymptomatic, a surgical resection was indicated since the lipoma could cause an embolism and arrhythmias and its potential to enlarge. Surgery revealed an intramyocardial lipoma on the atrial free wall which was confirmed by histopathology. The patient remained asymptomatic after surgery, and no recurrence was seen after 1 year.

          Conclusions

          Although cardiac lipomas are usually benign, tumor embolism, potential to enlarge, or intracardiac obstruction can cause a critical situation. Therefore, a surgical resection was indicated even in asymptomatic patients.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12957-015-0441-9) contains supplementary material, which is available to authorized users.

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          Most cited references18

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          Tumors of the heart. A 20-year experience with a review of 12,485 consecutive autopsies.

          K Y Lam, P Dickens, A Chan (1993)
          Cardiac involvement by primary and secondary tumors is one of the least investigated subjects in oncology. Seven cases of primary and 154 cases of secondary cardiac tumors from autopsies performed over a 20-year period (1972 through 1991) at Queen Mary Hospital, Hong Kong, were reviewed. During this period, 12,485 autopsies were performed, and the autopsy incidence for primary and secondary heart tumors is thus 0.056% and 1.23%, respectively. Only seven primary cardiac tumors were found, including two myxomas, two rhabdomyomas, two hemangiomas, and one lipoma. For secondary tumors involving the heart (including both metastasis and local extension), important primary tumors in male subjects were carcinoma of the lung (31.7%), esophageal carcinoma (28.7%), lymphoma (11.9%), carcinoma of the liver (6.9%), leukemia (4.0%), and gastric carcinoma (4.0%), while in female subjects, carcinoma of the lung (35.9%), lymphoma (17.0%), carcinoma of the breast (7.5%), and pancreatic carcinoma (7.5%) predominated. Overall, the three most common malignant neoplasms encountered were carcinoma of the lung, esophageal carcinoma, and lymphoma. Pericardium, including epicardium, was the most common location of cardiac involvement by secondary tumors, followed by myocardium and endocardium. The present study showed a higher percentage of esophageal carcinoma and carcinoma of the liver (reflecting the higher incidence of these tumors in Hong Kong Chinese), but a lower incidence of carcinoma of the breast when compared with other series. The metastatic lung tumors showed an unusual predominance of adenocarcinoma.
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            Cardiac Masses on Cardiac CT: A Review

            David Kassop, Michael S. Donovan, Michael Cheezum … (2014)
            Cardiac masses are rare entities that can be broadly categorized as either neoplastic or non-neoplastic. Neoplastic masses include benign and malignant tumors. In the heart, metastatic tumors are more common than primary malignant tumors. Whether incidentally found or diagnosed as a result of patients’ symptoms, cardiac masses can be identified and further characterized by a range of cardiovascular imaging options. While echocardiography remains the first-line imaging modality, cardiac computed tomography (cardiac CT) has become an increasingly utilized modality for the assessment of cardiac masses, especially when other imaging modalities are non-diagnostic or contraindicated. With high isotropic spatial and temporal resolution, fast acquisition times, and multiplanar image reconstruction capabilities, cardiac CT offers an alternative to cardiovascular magnetic resonance imaging in many patients. Additionally, cardiac masses may be incidentally discovered during cardiac CT for other reasons, requiring imagers to understand the unique features of a diverse range of cardiac masses. Herein, we define the characteristic imaging features of commonly encountered and selected cardiac masses and define the role of cardiac CT among noninvasive imaging options.
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              Primary cardiac tumors.

              N Silverman (1980)
              Cardiac tumors are a rare, but potentially curably form of heart disease. A high index of clinical suspicion is necessary for diagnosis as these tumors have protean manifestations that mimic a variety of other cardiac and noncardiac diseases. Presently, M-mode and two-dimensional echocardiography are utilized as safe, reliable, and noninvasive imaging modalities. Seventy-five per cent of these tumors are benign, with myxoma accounting for 50% and rhabodomyoma comprising 20% of lesions. Various histologic types of sarcoma are the predominant malignant cardiac neoplasms. With strict attention to avoiding perioperative tumor embolization, surgical resection of these lesions can be accomplished with minimal morbidity and mortality. Sixteen consecutive primary tumors of the heart have been surgically treated at Duke University Medical Center since 1966 with no perioperative deaths and no late recurrences.
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                Author and article information

                Contributors
                Haiyong Wang: docwanghy@sina.com
                Jiangwei Hu: 472556577@qq.com
                Xiaolin Sun: sxlshandong@163.com
                Pingshan Wang: wangps@163.com
                Zhenzong Du: 601700556@qq.com
                Journal
                Journal ID (nlm-ta): World J Surg Oncol
                Journal ID (iso-abbrev): World J Surg Oncol
                Title: World Journal of Surgical Oncology
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1477-7819
                Publication date (Electronic): 6 February 2015
                Publication date PMC-release: 6 February 2015
                Publication date Collection: 2015
                Volume: 13
                Electronic Location Identifier: 20
                Affiliations
                Department of Cardiothoracic Surgery, Affiliated Hospital of Guilin Medical University, Guilin, 541001 China
                Article
                Publisher ID: 441
                DOI: 10.1186/s12957-015-0441-9
                PMC ID: 4332731
                PubMed ID: 25885214
                SO-VID: 2faadb14-32ed-4278-bdac-88379ec0a60e
                Copyright © © Wang et al.; licensee BioMed Central. 2015
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 23 October 2014
                Date accepted : 7 January 2015
                Categories
                Subject: Case Report
                Custom metadata
                issue-copyright-statement © The Author(s) 2015

                ScienceOpen disciplines: Surgery
                Keywords: heart neoplasm,diagnosis,surgery,lipoma
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: heart neoplasm, diagnosis, surgery, lipoma

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