What is the diagnosis and treatment for an interatrial cardiac lipoma (cardiac benign tumor)?

From the Guidelines

Interatrial cardiac lipomas should be surgically resected if symptomatic or large, as they can cause embolic events, similar to other cardiac tumors like myxomas, which have a high embolization rate of 30% to 40% 1. When considering the management of interatrial cardiac lipomas, it's crucial to understand that these tumors, although benign, can lead to significant morbidity if not properly addressed. The primary concern with any cardiac tumor is the potential for embolization, which can result in ischemic stroke, as highlighted in guidelines for the primary prevention of stroke 1.

Key Considerations

• Interatrial cardiac lipomas are composed of mature fat cells and are typically found in the interatrial septum.
• Symptoms, when present, can include palpitations, shortness of breath, chest pain, or arrhythmias, depending on the tumor's size and location.
• Diagnosis is confirmed through imaging techniques such as echocardiography, cardiac CT, or MRI, which are essential for differentiating lipomas from other cardiac masses.
• Management strategies depend on the presence of symptoms and the size of the lipoma, with asymptomatic small lipomas potentially being monitored with regular imaging, and symptomatic or large lipomas requiring surgical intervention.

Surgical Intervention

Surgical resection is the recommended treatment for symptomatic or large interatrial cardiac lipomas, aiming for complete excision of the tumor while preserving the heart's normal structures and function. This approach is similar to the management of other cardiac tumors like myxomas, where surgical excision is recommended due to the high risk of embolization 1. The prognosis after surgical removal is generally excellent, with low recurrence rates, emphasizing the importance of timely and appropriate intervention.

Distinction from Other Conditions

It's essential to distinguish interatrial cardiac lipomas from lipomatous hypertrophy of the interatrial septum, a non-neoplastic accumulation of fat that typically does not require intervention unless it causes significant symptoms. Understanding these differences is crucial for providing appropriate patient care and avoiding unnecessary interventions. Given the potential risks associated with cardiac tumors, including embolization and stroke, as outlined in guidelines for stroke prevention 1, a cautious approach that prioritizes patient safety and outcomes is warranted.

From the Research

Interatrial Cardiac Lipoma

• Interatrial cardiac lipoma is a rare benign tumor of the heart, which can be asymptomatic or symptomatic depending on its location and size 2, 3, 4.
• The typical locations of cardiac lipomas are the endocardium of the right atrium and the left ventricle, but they can also occur in other areas, including the interatrial septum 2, 4.
• Diagnostic modalities for cardiac lipomas include echocardiogram, cardiac MRI, and cardiac CT, with cardiac MRI being the diagnostic modality of choice for better tissue characterization 2, 3, 5.
• Treatment guidelines for cardiac lipomas have not been established due to their low prevalence, but surgical resection is often performed to relieve symptoms, especially in symptomatic patients 2, 3, 4, 5.
• Lipomatous hypertrophy of the interatrial septum is a benign cardiac mass that can be misdiagnosed as a malignant tumor, but can be diagnosed using non-invasive imaging modalities without the need for a tissue biopsy 6.
• The prognosis for patients with cardiac lipomas is generally good, especially after surgical resection, but can be poor for patients with lipomas involving ventricles and myocardial infiltration 4, 5.

Symptoms and Diagnosis

• Symptoms of interatrial cardiac lipoma can range from shortness of breath to syncope, depending on the size and location of the tumor 2, 3, 4.
• Echocardiogram is often the first line of diagnosis, but cardiac MRI and cardiac CT can provide more detailed information and help differentiate cardiac lipomas from other cardiac tumors 2, 3, 5.
• Cardiac lipomas can be clinically symptomatic, presenting with symptoms in over half of the reported cases, but can also be asymptomatic even in large dimensions 4, 5.

Treatment and Prognosis

• Surgical resection is the mainstream treatment for symptomatic cardiac lipomas, with over 80% of symptomatic patients undergoing resection 4.
• Prophylactic resection is also performed in asymptomatic patients, especially if the tumor is large or has the potential to cause symptoms 4.
• The recurrence rate after cardiac lipoma excision is low, but can be higher for patients with lipomas involving ventricles and myocardial infiltration 4, 5.