A Rounded Cardiac Mass

Cardiac lipomas are rare and frequently asymptomatic. However, they are increasingly diagnosed due to advanced imaging modalities.

Here we present a case of a large right atrial interdigitating lipoma in a female teenager. After having vague symptoms for 3 years, she was referred to a cardiologist. An electrocardiogram showed an isolated P pulmonale suggestive of right atrial enlargement. A 2-dimensional echocardiogram showed a large semirounded right atrial mass. A magnetic resonance imaging scan was consistent with a lipoma. Open heart surgery was performed, and the tumor was resected. Pathology confirmed the presence of an interdigitating benign lipoma, an exceedingly rare tumor.

About 300 to 400 cases of cardiac lipoma are reported in the literature. Most cardiac lipomas are composed of mature white adipose tissue. They occur most frequently in the right atrium. Although they may be asymptomatic, they may have a wide range of symptoms including sudden death. Surgical resection is sometimes a challenge owing to tumor size and location.

Simple diagnostic tools followed by advanced imaging are leading to detecting more and more rare cardiac diseases, including masses. Early intervention could lead to better outcomes.