Right atrial mass-multimodality imaging—Massive lipomatous h
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Asymptomatic cardiac neoplasms are often diagnosed incidentally. Right atrial mass close to septum needs careful evaluation and multimodality imaging to manage appropriately. This case highlights the utilization of multimodality imaging and heart team approach in the management of the right atrial mass.

A 68-year-old Caucasian woman presented with complaints of shortness of breath. Chest computer tomography (CT) scan showed no pulmonary embolism but incidentally noted right atrial mass around 6.2 × 3.9 × 7.4 cm. Underwent cardiac magnetic resonance imaging (MRI) which showed tissue characteristics consistent with fat (lipoma vs lipomatous hypertrophy of the atrial septum [LHAS]). In both imaging, studies noted compression of superior vena cava (SVC). She also had trans-esophageal echocardiogram (TEE) which showed the similar findings and classic dumbbell-shaped mass sparing of fossa-ovalis region confirming the LHAS. With compression of the SVC, doctors consulted cardio-thoracic surgery and interventional cardiology who recommended conservative management as she does not have SVC syndrome.

LHAS is usually a benign condition but symptoms can occur due to compression or arrhythmias. Differential diagnosis includes LHAS, intra-cardiac malignancies, myxoma, and lipoma. TEE has high sensitivity and specificity for detecting masses in the heart but further differentiation can be achieved with cardiac MRI and CT. Lipoma is also similar to LHAS but it is more of an encapsulated mass of mature and fetal adipocytes. This case illustrates multimodality imaging and heart team approach treating the cardiac masses.

Source: https://onlinelibrary.wiley.com/doi/full/10.1002/ccr3.3431?af=R