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Right atrial lipoma: A case report and literature review
Mircea Bajdechi1,2,3, Sebastian Onciul1, Victor Costache4
1First Department, Medical Semiology, 'Carol Davila' University of Medicine and Pharmacy, Bucharest 050474, Romania.
Insights
Cardiac lipomas are rare heart tumors. While often asymptomatic, they can cause symptoms like dyspnea and outflow tract obstruction, necessitating surgical intervention, sometimes minimally invasively.
Area of Science:
- Cardiology
- Cardiac Surgery
- Diagnostic Imaging
Background:
- Cardiac lipomas are benign tumors of the heart, typically asymptomatic but can cause significant complications.
- Accurate diagnosis relies on multimodality imaging, distinguishing them from other cardiac masses.
Observation:
- A case report details a 30-year-old man with an asymptomatic atrial lipoma.
- A literature review identified 26 cases of right atrial lipomas, with 80% symptomatic (e.g., dyspnea) and 42% causing right ventricular outflow tract obstruction.
Findings:
- Echocardiography is a primary diagnostic tool, complemented by cardiac MRI and CT for precise characterization.
- Surgery is the preferred treatment, with a high rate of intervention (92%) in reviewed cases.
Implications:
- Minimally invasive approaches are emerging as a viable surgical option.
- Multimodality imaging and careful risk-benefit assessment are crucial for managing cardiac lipomas.
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.
