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A: transthoracic echocardiogram (TTE): showing a mobile mass in right atria. B: transesophageal echocardiogram (TEE) shows mass in right atria. C: transesophageal echocardiogram (TEE) image of the R atrial mass and with approximate size. D: transthoracic echocardiogram (TTE) 1 year post surgery.
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Primary tumors of the heart are exceedingly rare, accounting for less than 5% of all cardiac tumors; the remaining 95% of tumors are metastatic tumors to the heart. The most common primary cardiac tumors in adults are myxomas (usually occurring in the left atrium) followed by papillary fibroelastomas and lipomas with rhabdomyoma the most common in...
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Cardiac rhabdomyoma is the most common primary pediatric tumor of the heart. We report a 1-month old male infant who presented to our institute for routine cardiac evaluation since he was diagnosed to have a cardiac mass in the right ventricle (RV) in utero. After he was born, an echocardiogram showed two large cardiac masses occupying entire RV ca...
Introduction. Primary cardiac tumors in children are rare and the majority of them are diagnosed before the age of one year. They are mainly rhabdomyomas and have a tendency to regress. The incidence of arrhythmias is not well-defined, depending on the size and location of tumors. Case outline. The authors report a female neonate with ongoing fetal...
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BACKGROUND: Cardiac rhabdomyoma (CRs) are the most common primary tumour of the heart in infants and children. Usually are multiple and, basing on the location can cause a haemodynamic disturbance, dysrhythmias or heart failure during the fetal and early postnatal period. CRs have a natural history of spontaneous regression and are closely associat...
Citations
... 2 Lipoma may occur in individuals of different ages and gender; however, it is more common among elderly patients. 1,8 Moreover, lipoma constitutes a minority of primary cardiac tumors in children, and only a few pediatric cases diagnosed with cardiac lipoma have been reported. 2 Lipomas are often intracardiac sessile masses originating primarily from the subendocardium (50%), followed by an equal distribution of the subepicardium and myocardium (25%). ...
Highlights
•Cardiac lipoma is exceedingly rare in both adult and pediatric populations.
•Only a few cases of papillary muscle lipoma have been reported.
•TTE is the first step in detecting a cardiac mass.
•CMR contributes to the diagnosis of cardiac lipoma.
•There are no specific guidelines for the treatment of papillary muscle lipoma.
... Cardiac NMRI reveals the tissue composition of the tumor, the degree of invasion into the cardiac structures, and the effects on hemodynamics. [20] Due to the high resolution of T 1 -and T 2 -weighted scans, cardiac MRI allows for a precise evaluation of the nature of the tumor and the degree of invasion, [17,21] and it can be used preoperatively to determine whether complete resection of the tumor can be achieved. In this study, 13 patients underwent cardiac MRI preoperatively, and two of them were determined to have invasive growth into the myocardium. ...
Background:
Primary cardiac lipoma is very rare, and no consensus has been developed regarding its ideal treatment strategy. This study reviewed the surgical treatment of cardiac lipomas in 20 patients over 20 years.
Methods:
Twenty patients with cardiac lipomas were treated at Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College from January 1, 2002, to January 1, 2022. The patients' clinical data and pathological reports were retrospectively analyzed, and the follow-up with a range of 1 to 20 years was conducted.
Results:
The cardiac lipomas were located in the right atrium (RA) or superior vena cava (SVC) in seven patients (35%) (atrium in six patiets and SVC in one patient), left ventricle in eight patients (40%) (left ventricular chamber in four patients and left ventricular subepicardium and myocardium in four patients), right ventricle in three patients (15%) (right ventricular chamber in one patient and right ventricular subepicardial layer and myocardium in two patients), subepicardial interventricular groove in one patient (5%), and pericardium in one patient (5%). Complete resection was achieved in 14 patients (70%), including seven patients with lipomas in the RA or SVC. Incomplete resection occurred in six patients (30%) with lipomas in the ventricles. No perioperative deaths occurred. Long-term follow-up was conducted for 19 patients (95%), including two (10%) who died. Both patients who died had lipomas incompletely resected due to ventricles involvement, and preoperative malignant arrhythmias persisted post-operatively.
Conclusions:
The complete resection rate was high, and the long-term prognosis was satisfactory in patients with cardiac lipomas that did not involve the ventricle. The complete resection rate was low in patients with cardiac lipomas in ventricles; and complications, including malignant arrhythmia, were common. Failure of complete resection and post-operative ventricular arrhythmia are correlated with post-operative mortality.
... Доказването на хомогенно мастно съдържимо в един тумор стеснява диагнозата до липом, ако има мастна капсула и добре демаркирана формация, и липоматозна хипертрофия, при която има мастно разрастване и инфилтрация без наличие на капсула [1,6,8,9,10]. Липоматозната хипертрофия е по-често срещана [4,5] и засяга интератриалния септум, но типично без fossa ovalis [1,3,8,9,10], както е и при нашия клиничен случай. ...
... Demonstration of homogeneous fatty content in a tumor narrows the diagnosis to lipoma if the mass is well defined and there is a capsule and lipomatous hypertrophy, in which there is fatty growth and infiltration, without the presence of a capsule [1,6,8,9,10]. Lipomatous hypertrophy is more common [4,5], often affects the interatrial septum, but typically without the fossa ovalis [1,3,8,9,10], as is in our clinical case. ...
A patient was admitted to our institution with a diagnosis of a cardiac tumor, most likely myxoma, in the right atrium, detected at echocardiography. The cardio-magnetic resonance examination was performed and depicts a homogeneous fatty content, fatty proliferation and hypertrophy along the wall of the right atrium and the interatrial septum, sparing the oval fossa and mimicking a tumor with a filling defect and with slight compression of the inferior and superior vena cava. With the help of double and triple inversion techniques, magnetic resonance imaging can give a tissue-specific diagnosis, in this case a fat-equivalent lesion of the type of lipoma or lipomatous hypertrophy, and thus save additional studies and predetermine the therapeutic approach.
... The most common cardiac tumors in adults are metastatic tumors (1). In autopsies, the incidence of primary cardiac tumors is <0.2% (2). ...
... Cardiac lipomas are rare entities, with a 2.9-8% incidence among all benign cardiac tumors, which positions them at the third place after myxomas and papillary fibroelastomas (3). Most cardiac lipomas do not cause symptoms, but they can be fatal when they cause arrhythmic or obstructive symptoms (1). They can be associated with symptoms that are related to the size and location (4). ...
... Cardiac lipomas may be asymptomatic even in large dimensions and are typically found incidentally on autopsies or via imaging methods (1,4). Regarding their incidence, there are no differences between age groups or sexes (4). ...
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.
... Contrary to these findings, it has been reported that acute Cd exposure of 5 mg/L for 1 h had almost no influence on Hct value in C. carpio, but Cd concentration of 10 mg/L for 24h resulted in a reduction in Hct levels of C. carpio (Witeska and Jiezierska, 1994). O. niloticus was subjected to various doses of cadmium chloride (CdCl 2 ) for a period of 240, 480, and 720 h and found that the Hb and Hct values were decreased in exposed fish to all periods (Al-Asgah et al., 2015). Naz et al., 2021 have reported that the Hb and Hct show a significant decrease upon exposure to Cd. ...
Environmental pollution caused due to the presence of heavy metals has become a great concern as it has an adverse effect on almost all types of ecosystem. In this sense, these pollutants have a tendency to pollute the aquatic ecosystem, thus badly affecting the health of aquatic organisms. As a result, toxicological studies believe them to be the most harmful pollutants in the aquatic environment. Among all the aquatic organisms, fish—being a chief organism in this system—become the easiest victim of these pollutants. Heavy metals enter fish bodies through the alimentary system by consumption of polluted food, or through the gills, and skin. They are finally delivered by the bloodstream to the organs and tissues where they accumulate after absorption. Ultimately, in this way heavy metals make their way into humans through the food chain. The fluctuations in the hematological values may serve as an initial indicator of the toxicant’s impact on fish health. It has been observed that when pollutants impact the quality of the aquatic medium, the first consequence is apparent in the form of physiological changes in fish, which are reflected in one or more hematological parameters, such as hemoglobin, hematocrit, red blood cell count, white blood cell count, etc. As a result of these alterations, fish become weak, anemic, and more susceptible to diseases. Over the past several decades, a vast number of studies have been reported on the qualitative and quantitative variations in hematological parameters due to the presence of heavy metal intoxication. Heavy metal contamination of water resources not only degrades the water quality but also negatively impacts the quality of food in the form of fish proteins. Therefore, this article sheds light on the effects of heavy metals on hemoglobin and hematocrit of fish hematology and calls for more attention to the protection and preservation of aquatic ecosystems, particularly those contaminated with heavy metals.
... Depending on their size and location, the symptoms of cardiac lipoma can include arrhythmias, syncope or stroke-like symptoms or even sudden death. 5,6 Symptoms can vary from chest pain, dyspnea, cough and palpitations depending on the local mass effect by intrathoracic lipoma. 3 Imaging modalities are useful for the diagnosis of cardiac lipoma and for ruling out other differentials. ...
... CT scan and MRI are accurate imaging modalities for diagnosis. 5,7 Bronchoscopy is indicated to assess the degree of airway compression. ...
... Surgical resection can be considered for symptomatic patients, with about 95% curative rate. 5 Due to chance of recurrence, complete resection is recommended. 8 ...
... Cardiac lipoma and LHIS typically have a benign course with asymptomatic subjects [2] . In symptomatic patients, the clinical symptoms and outcome vary depending on the tumor size and location [3] . Differentiating cardiac tumors is essential for symptomatic patients as treatment and prognosis vary [2] . ...
... Most patients with cardiac lipoma are asymptomatic; however, the clinical features of cardiac lipoma vary from dyspnea to palpitations, dizziness, decreased exercise tolerance, thromboembolism, and sudden death. An atypical presentation including fever of unknown origin, hypertension, and epistaxis have been noted [3] . A transthoracic echocardiogram performed in our patient for palpitation and decreased exercise tolerance showed the intracardiac masses. ...
Background:
Cardiac lipoma and lipomatous hypertrophy of interatrial septum (LHIS) are very rare disorders with distinct pathological features. While cardiac lipoma is a well-circumscribed encapsulated tumor of mature adipocytes, LHIS is due to entrapment of fat cells in the interatrial septum during embryogenesis. Although a biopsy is the definitive diagnostic test, these disorders can be differentiated by a cardiac magnetic resonance imaging (MRI). Treatment of LHIS is not warranted in asymptomatic patients. In symptomatic patients, surgical resection is the only recommended treatment, which has shown to improve good long-term prognosis.
Case summary:
A 63-year-old Caucasian woman with past medical history significant for hypertension, hypothyroidism, right breast ductal cell carcinoma treated with mastectomy and breast implant, platelet granule disorder, asthma requiring chronic intermittent prednisone use, presented to the outpatient cardiology office with recent onset exertional dyspnea, palpitations, weight gain and weakness. Initial workup with electrocardiogram and holter monitor did not reveal significant findings. During the subsequent hospitalization for community acquired pneumonia, the patient developed symptomatic paroxysmal atrial fibrillation. Transthoracic echocardiogram showed a right ventricular mass. A biopsy was not pursued given the high risk of bleeding due to platelet granule disorder. Cardiac MRI showed characteristic features consistent with cardiac lipoma and LHIS. Prednisone was discontinued. Genetic testing for arrhythmogenic right ventricular dysplasia and 24-h urine cortisol test was negative. As multiple attempts at rhythm control failed with sotalol and flecainide, pulmonary vein isolation and right atrial isthmus radiofrequency ablation were done. She is in follow-up with symptomatic relief and no recurrence of atrial fibrillation for 10 mo.
Conclusion:
Benign fatty lesions in heart include solitary lipoma, lipomatous infiltration and lipomatous hypertrophy of interatrial septum. Although transvenous biopsy provides a definitive diagnosis, Cardiac MRI is superior to computed tomography and aids in differentiating benign from malignant lesions. Surgical excision of cardiac lipoma along with capsule and pedicle removal generally prevents recurrence, but with our patient's unusual tumor features and comorbidities proscribed a surgical approach. Symptom management with antiarrhythmics and ablation techniques were successfully utilized.
... Cardiac lipomas are rare [3,4] and found mostly in asymptomatic patients [5,6] . A review of articles related to cardiac lipomas shows that interatrial septum is the most common position for lipomas and lipomatous hypertrophy [7] . ...
Background:
Cardiac lipomas are rare benign tumors commonly found in the right atrium or left ventricle. Patients are usually asymptomatic, and clinical presentation depends on location and adjacent structures impairment. Right ventricle lipomas are scarce in the literature. Moreover, the previous published cases were reported in over 18-year-old patients.
Case summary:
We report a giant right ventricle lipoma discovered incidentally in a 17-year-old female while performing preoperative work-up. The diagnosis was confirmed by histopathological examination, and a conservative approach was performed.
Conclusion:
Multimodal cardiac imaging and histopathological examination are required for a definitive diagnosis. The therapeutic approach depends on clinical presentation.
... Primary cardiac tumors are rare, accounting for less than 5% of all cardiac tumors [1]. Benign tumors comprise more than 75% of primary cardiac tumors, with myxomas being the most common, followed by papillary fibro-elastomas and lipomas. ...
Background:
A cardiac lipoma is a rare primary cardiac tumor. They are usually asymptomatic and carry a good prognosis. Cardiac Magnetic Resonance Imaging (CMR) is the confirmatory investigation of choice.
Case presentation:
We present a case of left ventricular lipoma in an asymptomatic patient, which was successfully treated with surgical resection.
Conclusion:
Cardiac lipomas are rare and are usually benign. There is no guideline on the management of cardiac lipomas and treatment is individualized.
... However, transesophageal echocardiography may provide a better, unobstructed view of the heart as it is not limited by an acoustic window and is uninterrupted by the chest wall or lungs [10]. In nonemergent situations, enhanced evaluation and confirmatory testing for a suspected cardiac lipoma can be achieved with cardiac computerized tomography (CCT) and cardiac magnetic resonance (CMR) [10,11]. A positron emission tomography and computed tomography (PET-CT) scan should also be obtained when attempting to accurately identify the presence or absence of metabolic activity within a suspected mass and reveal possible sites of lesion metastasis. ...
Although pericardial lipomas are both rare and benign, rapid or excessive growth can induce potentially fatal conditions such as pericarditis, arrhythmia, and cardiac tamponade. This case illustrates an example where a 65-year-old with atypical chest tightness unveiled a 10×15 cm anterior pericardial mass with circumferential effusion and progressive deterioration to cardiac tamponade. Initial transthoracic echocardiogram imaging was technically difficult in this patient due to habitus and body mass, which failed to illustrate underlying effusion. Recurrent bouts of refractory supraventricular tachycardia prompted further investigation of this patient’s presentation with transesophageal echocardiogram, which showed evidence of an echogenic mass with cardiac tamponade. An urgent pericardial window and pericardial lipectomy immediately relieved this hemodynamically compromising condition. Subsequent atrial flutter resulted with the removal of the anterior fat pad during surgery, complicating recovery.
