"Benign but Troubling Fat ball” behind the Scenes of a Rare Tumour: A Case Report of Intracardiac Lipoma

Abstract

Background: Primary intracardiac tumours are very rare, accounting for less than 5% of all cardiac tumours. Cardiac lipomas are the commonest non-myxomatous benign primary intracardiac neoplasms. They may cause non-specific symptoms or be completely asymptomatic even in large dimensions. The diagnosis relies on multimodality imaging methods, especially magnetic resonance imaging (MRI), which can be crucial in identifying and characterising these cardiac masses. To this day, management of cardiac lipomas remains controversial. Case Report: We present the case of a 72-year-old woman with a history of hypertension, who came to our department for a routine check-up. She was completely asymptomatic.  Transthoracic echocardiography revealed a fortuitous hyperechoic mass in the left atrium. Complementary cardiac magnetic resonance imaging (MRI) described characteristic features compatible with intra-atrial lipoma. It revealed an oval immobile smooth mass, measuring 26x36mm, attached to the interatrial septum, with increased signal on T1-weighted images with decreased fat-saturated sequences. Conservative management was chosen, and the patient was scheduled for regular follow-ups with a stable outcome. Conclusion: This case emphasises the relevance of cardiac MRI in diagnosing cardiac lipomas after an incidental finding. Surgery is recommended for treating symptomatic patients. In asymptomatic patients, management can be conservative with clinical observation, although prophylactic resection could be discussed.