Tumors of the Heart

Mary N Sheppard; Raad Mohiaddin

Disclosures

Future Cardiol. 2010;6(2):181-193. 

In This Article

Lipoma

Lipomas can occur in the heart, including in the visceral and parietal pericardium. Parietal pericardial lipomas are often clinically mistaken for pericardial cysts. Multiple myocardial lipomas have been described in tuberous sclerosis. Most lipomas occur in the epicardium, but in cases of multiple tumors, they can occur anywhere and have been reported on cardiac valves and obstructing coronary ostia causing sudden death.[18] They are a well-defined mass of mature fat, are well encapsulated and contain few myocytes in contrast to lipomatous hypertrophy, which is always found in the interatrial septum and is not encapsulated. Usually, lipomas are an incidental finding and rarely cause symptoms such as arrhythmias or obstruction, depending on their size and location.

Lipomatous Hypertrophy of the Atrial Septum & Lipoma

The interatrial septum largely consists of an invagination of the atrial roof and contains epicardial fat. This fat is the source of the entity known as lipomatous hypertrophy of the atrial septum, which is in fact characterized by excess accumulations of mature adipose tissue and brown fat admixed with residual myocytes, forming a recognizable mass that exceeds 2 cm in diameter (Figures 7 & 8). These masses are usually asymptomatic but may rarely present with arrhythmias or obstruction. They are commonly detected by routine echocardiography and are associated with older age, female sex, obesity and steroid use.

Figure 7.

Lipomatous hypertrophy of the interatrial septum. (A) Steady state free precession image in the horizontal long axis of the left ventricle and (B) with fat-suppressed short tau inversion recovery image. The lesion (†) and the pericardial/epicardial fat appear bright in (A) and dark (suppressed signal) in (B).
lv: Left ventricle; ra: Right atrium; rv: Right ventricle.

Figure 8.

Lipomatous hypertrophy of the interatrial septum. Note the ill-defined area of fat expansion in the interatrial septum.

Cardiac lipomas may occur anywhere in the heart and are well-defined masses of mature fat that are well encapsulated and contain few myocytes in contrast to lipomatous hypertrophy, which is always in the interatrial septum and is not encapsulated. Cardiac lipomas most frequently occur on the epicardial surface of younger patients. They are usually an incidental finding and rarely cause symptoms such as arrhythmias or obstruction, depending on their size and location.

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