Methodist Journal

IN THIS ISSUE

Nutritional Supplements and the Heart

Vol 15, Issue 3 (2019)


FEATURED GUEST EDITOR

ISSUE INTRO

Dietary Supplements: Facts and Fallacies

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RECOGNITIONS

Drs. Raizner and Cooke Take the Lead in Special Issue on Supplements

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REVIEW ARTICLES See More

Recent Clinical Trials Shed New Light on the Cardiovascular Benefits of Omega-3 Fatty Acids

Supplemental Vitamins and Minerals for Cardiovascular Disease Prevention and Treatment

Coenzyme Q10

Red Yeast Rice for Hypercholesterolemia

Inorganic Nitrate Supplementation for Cardiovascular Health

Vitamin D and Calcium Supplements: Helpful, Harmful, or Neutral for Cardiovascular Risk?

Cardiovascular Risk of Proton Pump Inhibitors

Advanced Cardiac Imaging for Complex Adult Congenital Heart Diseases

CASE REPORTS See More

A Rare Case of Pancreatitis-Induced Thrombosis of the Aorta and Superior Mesenteric Artery

Anomalous Origin of the Right Coronary Artery from the Left Main Coronary Artery in the Setting of Critical Bicuspid Aortic Valve Stenosis

Simultaneous Transfemoral Mitral and Tricuspid Valve in Ring Implantation: First Case Report with Edwards Sapien 3 Valve

Uneventful Follow-Up 2 Years after Endovascular Treatment of a High Flow Iatrogenic Aortocaval Fistula Causing Pulmonary Hypertension and Right Heart Failure

MUSEUM OF HMH MULTIMODALITY IMAGING CENTER See More

Snoopy’s Heart: A Case of Complete Congenital Absence of the Pericardium

CLINICAL PERSPECTIVES See More

POINTS TO REMEMBER

Herbal Nephropathy

EXCERPTA

Rolling the Dice on Red Yeast Rice

POINTS TO REMEMBER

The Kidney in Congenital Cyanotic Heart Disease

EXCERPTA

Talking Statins with Antonio Gotto

EDITORIALS

Letter to the Editor in Response to “Cardiac Autonomic Neuropathy in Diabetes Mellitus”

Vol 15, Issue 2 (2019)

Article Full Text

MUSEUM OF HMH MULTIMODALITY IMAGING CENTER

Do I Look Fat in This? Multimodality Imaging Findings of a Cardiac Lipoma

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Article Citation:

Al-Sabeq B, Autry K, Nabi F. Do I Look Fat in This? Multimodality Imaging Findings of a Cardiac Lipoma. Methodist DeBakey Cardiovasc J. 2019;15(2):156-7.



Keywords
lipoma , cardiac magnetic resonance , computed tomography , positron emission , multimodality imaging

CASE PRESENTATION

A 59-year-old woman with a 6-month history of exertional dyspnea and worsening fatigue underwent cardiac magnetic resonance imaging (CMR) to further characterize a left ventricular mass incidentally noted on transthoracic echocardiography. The mass attached to the mid-anterior wall, measured 2.6 cm in its major axis, and displayed the following tissue characteristics: hyperintensity to myocardium with T1 weighted imaging (Figure 1 A, B), lack of perfusion with first-pass imaging of gadolinium-based contrast agent (Figure 1 C), and signal loss with T2 weighted fat saturation sequences (Figure 1 D). Combined computed tomography (CT) and positron emission tomography (PET) imaging revealed a hypodense mass that did not enhance with contrast administration, Hounsfield units of -82 consistent with adipose density, and low uptake of fluorodeoxyglucose (Figures 2, 3). In summation, the findings were virtually diagnostic of an intracardiac lipoma.

Cardiac lipomas are primary tumors of the heart that consist of an encapsulated collection of adipocytes. Although classified as benign lesions, they may lead to symptoms depending on their size, location, and compressive effects on cardiac chambers or interference with the conduction system. Whether cardiac1,2 or extracardiac,3 lipomas display characteristic CMR findings, with the elegant demonstration of hypointensity on fat suppression imaging being its sina qua non feature. Supportive CT findings include an encapsulated mass with fat density Hounsfield units usually between -90 and -110 and homogeneous hypoenhancement with the administration of iodine-based contrast.1,2 Although the role of PET is less well established for cardiac lipomas, extracardiac lipomas demonstrate reduced metabolic activity as evidenced by low avidity for fluorodeoxyglucose with correspondingly low standardized uptake values.4,5

Our case demonstrates classic noninvasive cardiac imaging findings of this tumor type. A conservative “watch and wait” strategy was recommended, and repeat CMR 3 months later did not demonstrate interval growth of the lipoma.

Figure 1. Cardiac magnetic resonance imaging showing hyperintense signal of the left ventricular mass on dark blood T1 weighted imaging in (A) short axis and (B) 4-chamber long axis views, (C) lack of perfusion of the mass with first-pass administration of gadolinium-based contrast, and (D) complete signal void with T2 fat suppression imaging.
Figure 2. Axial computed tomography slice showing low Hounsfield units of -82 when the left ventricular mass is sampled, consistent with adipose tissue.
Figure 3. Combined positron emission (PET) and computed tomography (CT) images showing  (A) a hypodense left ventricular mass with virtually no uptake of fluorodeoxyglucose (18F-FDG), suggesting (B) a benign etiology due to lack of metabolic activity. (C) A hybrid PET/CT axial slice.
Conflict of Interest Disclosure

The authors have completed and submitted the Methodist DeBakey Cardiovascular Journal Conflict of Interest Statement and none were reported.

References
  1. Sivrioglu AK, Ozturk E, Geceer G, Incedayi M, Kara K. Incidental right atrial lipoma: appearance on multidetector computer tomography imaging. Hellenic J Cardiol. 2014;55:422-3.
  2. Barbuto L, Ponsiglione A, Del Vecchio W, et al. Humongous right atrial lipoma: a correlative CT and MR case report. Quant Imaging Med Surg. 2015 Oct;5(5):774-7.
  3. Filli L, Huber A, Husain NA. Symptomatic lipoma of the internal auditory canal: CT and MRI findings. A case report. Neuroradiol J. 2014 Sep;27(4):479-81.
  4. Costelloe CM, Chuang HH, Chasen BA, et al. Bone windows for distinguishing malignant from benign primary bone tumors on FDG PET/CT. J Cancer. 2013 Aug 9;4(7):524-30.
  5. Shin DS, Shon OJ, Han DS, Choi JH, Chun KA, Cho IA. The clinical efficacy of 18F-FDG-PET/CT in benign and malignant musculoskeletal tumors. Ann Nucl Med. 2008 Aug;22(7):603-9.

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