Visualisation of Cardiac Lipoma by Multi-slice Computed Tomography and Magnetic Resonance Imaging
Hsin-Bang Leua, Mei-Han Wub, Wen-Chung Yua
aDivision of Cardiology, Department of Medicine, bDepartment of Radiology, Taipei Veterans General Hospital and National Yang-Min University, Taiwan
An asymptomatic, 23-year old man was referred to our institution for cardiac examination due to an abnormal heart murmur heard during a routine check-up. Trans-thoracic echocardiography revealed a well-defined immobile echo-dense mass in the postero-lateral wall of the left ventricle (Figure 1A & 1B). He then received ECG-gated multi-slice computed tomography (MSCT) for further evaluation. The MSCT of the heart showed a myocardium base fat-containing homogeneous soft tissue mass of approximately 20 mm at the postero-lateral wall of the left ventricle (Figure 1C & 1D). Cardiac lipoma was diagnosed because of high echodensity demonstrated by echocardiography and fat attenuation (Hounsfield measurement: -150) in the CT image. Cardiac magnetic resonance (MR) also confirmed the diagnosis of lipoma because of signal intensity characteristic of fat (Figure 1E & 1F).
The history of the patient was inconspicuous; routine laboratory parameters, the screening for genetic coagulation disorders, as well as systemic diseases, showed no pathologic findings. No cardiac pathology was found during echocardiography. Remarkably, computed tomography demonstrated non-existence of the right brachiocephalic vein and extensive venous collateralization of the thorax without any hint of a primary or secondary malignant process. Contrast-enhanced, three-dimensional Magnetic resonance (MR) venography showed a high-grade stenosis of the left brachiocephalic vein (BCV, panel 1A).
MSCT and MR provide useful information about spatial relationship of a cardiac tumour and myocardium, and the natural difference between the density of the fatty tissue and myocardium makes MSCT and MR useful tools for assessing the extent of cardiac lipoma.
Figure legend
Figure 1. Trans-thoracic echocardiography in four-chamber view (A) and short-axis view (B) showed an immobile echogenic mass in the postero-lateral wall of the left ventricle (arrow). MSCT images of heart with four-chamber view (C) and short-axis view (D) showed a fat-containing tumour at the postero-lateral wall of the left ventricle, protruding into the left ventricle. (E) T1-weighted magnetic resonance image of heart (short axis) showed high fat-containing signal intensity in the lateral wall of left ventricle and (F) the signal dropout on the fat-saturated image.
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