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12-leads ECG showed sinus rhythm (heart rate 65 beats/min) and P-wave abnormalities consisting of amplitude <1.0 mm in lead III, duration >100 ms, and "notching" configuration.
Source publication
A mass was identified in the atrial septum by clinical imaging in a patient who had multiple large lipomas of the skin. Multislice computed tomography and magnetic resonance imaging indicated that the interatrial mass was a fatty infiltration. In order to discriminate the myocardial lesion from myxoma and other benign conditions and malignant tumor...
Similar publications
We undertook this study to determine the CT findings of lipomatous hypertrophy of the interatrial septum, an asymptomatic and underrecognized benign proliferation of fat within the atrial septum.
We retrospectively identified 12 cases of lipomatous hypertrophy of the interatrial septum by searching the radiology records at our institution from 1991...
Citations
... LHIS is usually asymptomatic, but some cases involving intractable atrial arrhythmia or severe superior vena cava obstruction requiring surgical excision with septal reconstruction have been reported. 3,4 In patients with cardiac fatty tumors arising from the interatrial septum, LHIS should be considered in the differential diagnosis. If differentiation of cardiac tumors on non-invasive imaging modalities is difficult, ICE-guided cardiac biopsy may be a useful diagnostic method. ...
... However, of the 42 cases of LHAS retrieved in that study, 39 lesions were autopsy findings and only 3 cases have been resected surgically thus highlighting the rarity of clinically diagnosed and resected LHAS. LHAS is rare [14,15]. Since its first description in a series of five autopsy cases by Pior in 1964 [16], less than 300 cases have been reported [13,17]. ...
Background . Lipomatous hypertrophy of the atrial septum (LHAS) is a rare entity characterized by mass-forming deposition of fatty tissue within the atrial septum. To date, <300 cases have been reported; many of them were autopsy findings. The clinical presentation of LHAS varies from incidental asymptomatic mass (most frequent form) to severe life-threatening cardiovascular complications necessitating emergency cardiac surgery. Case Presentation . Here, we present the successful surgical resection of such a massive LHAS which was found incidentally on preoperative investigation of a 71-year-old patient with progressive coronary heart disease. Histology confirmed the diagnosis of lipomatous hypertrophy of the atrial septum. Conclusions . The described case report illustrates an unusual example of LHAS in a patient undergoing a planned coronary artery bypass surgery. In this case, surgical intervention was justified to avoid later outflow obstructions.
... Lipomatous hypertrophy of the interatrial septum; Cardiac tumours; Transesophageal echocardiography; Vena cava obstruction Background Lipomatous hypertrophy of the interatrial septum (LHIS) is a benign cardiac mass characterized by massive fatty deposits in the interatrial septum (IAS). [1][2][3][4] With a still unknown aetiology and once described as a relatively rare condition, the expanding use of non-invasive imaging techniques in recent years leaded to an increase in the reported incidence up to 8%. 5,6 The common imaging tool to evaluate LHIS is transthoracic and transoesophageal echocardiography, where the IAS appears unusually thick sparing the membrane of the fossa ovalis, giving the mass the typical dumbbell shape. ...
Lipomatous hypertrophy of the interatrial septum (LHIS) is an increasingly recognized heart condition characterized by fatty deposits in the interatrial septum with sparing of the fossa ovalis. Its distinctive characteristic features by imaging techniques, benign nature, and the fact that most patients remain asymptomatic, has limited the need for histological confirmation and operative intervention in most cases. In this report, we describe two cases of LHIS where cardiac surgical intervention was indispensable: in the first patient, due to the presence of an additional left atrial tumour found out as mixoma and in the second, to relief a superior vena cava obstruction together with bypass grafts for severe coronary artery disease. Histological samples of the interatrial septal lesion were obtained in both cases either because of uncertainty of the diagnosis (Case 1) or to confirm the diagnosis (Case 2).
Background
Lipomatous atrial septal hypertrophy (LASH) with atrial septal defect (ASD) is a rare congenital anomaly. Although LASH is a histologically benign cardiac lesion characterized by excessive fat deposition in the interatrial septum that spares the fossa ovale, it has been associated with supraventricular arrhythmias or sick sinus syndrome. Application of multimodal imaging is crucial for accurate diagnosis, appropriate treatment of LASH with ASD, and follow-up.
Case summary
A 68-year-old female patient presented with recurrent chest tightness and palpitation. Multimodal imaging revealed the characterizations of LASH and ASD. Two-dimensional transesophageal echocardiography showed a “dumbbell”-shaped involvement of the cephalad and caudal regions with sparing of a single secundum ASD. The septum with a brightness feature is an uncommon condition characterized by the deposition of unencapsulated fat cells in the atrial septum. Real-time four-dimensional transesophageal echocardiography reflected the lipomatous hypertrophy of the atrial septum and an oval-shaped ASD. Cardiac computer tomography angiography later confirmed this finding. The patient achieved a good clinical response with an ASD percutaneous occlusion guided by intracardiac echocardiography (ICE).
Conclusion
This case demonstrates a LASH combined with ASD. Multimodality imaging can provide an accurate diagnosis and may guide the procedure for precise occlusion.
Introduction: Lipomatosis is the excessive accumulation of subcutaneous adipose tissue mostly on the extremities, trunk and buttocks, and sometimes it coexists with systemic lipomas. Aetiopathogenetic theories include defect of brown adipose tissue, alterations in lipid metabolism, and hereditary factors, but alcoholism, neuropathies, and metabolic disorders have also been also underlined. Treatments of choice are excisional surgery, liposuction, and lipectomy, or lipolysis sometimes together with a reducing diet, and pharmacological therapy. Material and methods: There were 6 patients who underwent surgical treatment for multiple lipomas at the Department of Plastic Surgery, Medical University of Łódź in the years 1999-2008. We analysed aetiopathogenesis of the lipomatosis, coexistence of other anomalies, and methods of surgical management of the tumours. Results: Postoperative results in patients of the studied group were good. Conclusions: We confirmed neither the influence of aetiopathogenetic factors nor the coexistence of similar systemic disorders.
Benign lipomatous lesions of the heart encompass an apparently etiologically diverse group of entities, including neoplastic, congenital, and reparative phenomena. Among these, lipomas and lipomatous hypertrophy of the atrial septum (LHAS) represent two commonly encountered mass lesions. To date, no study has systematically and comparatively evaluated the morphologic and genetic characteristics of these lesions. Tissue registry archives of Mayo Clinic were queried for cases of cardiac lipoma and LHAS (1994–2011). Clinical, imaging and pathological findings were reviewed. Representative cases in each cohort were evaluated by fluorescence in situ hybridization (FISH) for HMGA1 and HMGA2 loci rearrangement and for MDM2/CPM locus amplification. Five cases of cardiac lipoma were identified (mean age 67 years, range 48–101; 3 men); 4 right atrial and 1 left ventricular. 42 cases of LHAS were identified (mean age 75.6 years, range 45–95, 20 men), 39 of which were autopsy-derived. The median size was 3.4 cm for lipomas, and 2.8 cm for LHAS (n = 14). A single case each of cardiac lipoma and LHAS were found to harbor HMGA2 rearrangement, while no case showed cytogenetic abnormality of HMGA1 or CPM. This represents the largest series of histopathologically confirmed cardiac lipomas from a single institution. Additionally, it is the first to evaluate cardiac lipomas and LHAS for genetic alterations associated with extracardiac lipomatous lesions. The genetic and morphologic similarities found provide evidence in support the neoplastic classification of cardiac lipomas. A single case of LHAS contained an HMGA2 rearrangement, challenging the currently accepted hypothesis of pathogenesis for this lesion.
