title: Invasive Cardiac Lipoma: a case report and review of literature.
abstract: Cardiac lipomas are rare benign tumors of the heart. They are usually asymptomatic and are thus most often diagnosed on autopsies. Symptoms, when present, depend upon the location within the heart. Typical locations are the endocardium of the right atrium and the left ventricle. Diagnostic modality of choice is cardiac MRI. Treatment guidelines have not yet been established due to the very low prevalence of these tumors and are thus guided by the patient's symptomatology.
  
  
  
  We describe a case of an invasive cardiac lipoma, wherein the initial symptom of the patient was shortness of breath. Although the echocardiogram visualized the tumor in the right atrium, a cardiac MRI was performed for better tissue characterization. The MRI revealed a large, fat containing, septated mass in the right atrium with invasion into the inter-atrial septum and inferior cavoatrial junction. There was also invasion of the coronary sinus along the inferior and left lateral aspect of the posterior atrioventricular groove. Although the mass appeared to represent a lipoma by imaging characteristics, the unusual extension into the coronary sinus led to consideration of a low-grade liposarcoma in the differential. Thus a pre-operative biopsy was performed along with MDM2 gene amplification to rule out a liposarcoma preceding surgical excision.
  
  
  
  Cardiac lipomas are well-characterized on cardiac MRI, which is the diagnostic modality of choice. Typical locations are the right atrium and the left ventricle. However, in those with atypical features such as invasion of the coronary sinus, pre-operative biopsy for histopathologic confirmation is imperative to exclude well-differentiated liposarcoma. Our patient with a simple lipoma underwent partial resection to relieve symptoms. We discuss prognosis and treatment of symptomatic cardiac lipomas.
authors.affiliation: Department of Internal Medicine, Florida Hospital, 2501 N. Orange Ave, Ste-235, Orlando, FL, 32804, USA. jason4j@gmail.com.
authors.forename: Jason
authors.identifier: 0000-0001-8460-0094
authors.initials: J
authors.lastname: D'Souza
authors.affiliation: Department of Cardiology, Florida Hospital, 251 Maitland Ave #116, Altamonte Sp, FL, 32701, USA.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Shah
authors.affiliation: Department of Internal Medicine, Florida Hospital, 2501 N. Orange Ave, Ste-235, Orlando, FL, 32804, USA.
authors.forename: Aamer
authors.initials: A
authors.lastname: Abbass
authors.affiliation: Department of Radiology, Florida Hospital, 601 E. Rollins, Orlando, FL, 32803, USA.
authors.forename: Jeremy R
authors.initials: JR
authors.lastname: Burt
authors.affiliation: Department of Internal Medicine, MedStar Health, 9000 Franklin square drive, Baltimore, MD, 21237, USA.
authors.forename: Aditya
authors.initials: A
authors.lastname: Goud
authors.affiliation: Department of Internal Medicine, MedStar Health, 9000 Franklin square drive, Baltimore, MD, 21237, USA.
authors.forename: Chanukya
authors.initials: C
authors.lastname: Dahagam
mesh_terms: D000328:Adult; D001706:Biopsy; D003937:Diagnosis, Differential; D004417:Dyspnea / Q000209:etiology; D004452:Echocardiography; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D006338:Heart Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008067:Lipoma / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D009361:Neoplasm Invasiveness; D011237:Predictive Value of Tests; D016896:Treatment Outcome; D047368:Tumor Burden
keywords: Benign cardiac tumor; Cardiac lipoma; Case report; Liposarcoma