Circulation. 2006;113:e778-e779
doi: 10.1161/CIRCULATIONAHA.105.589630
(Circulation. 2006;113:e778-e779.)
© 2006 American Heart Association, Inc.
Images in Cardiovascular Medicine |
Near Sudden Death From Cardiac Lipoma in an Adolescent
Mark K. Friedberg, MD;
Irene L. Chang, MD;
Norman H. Silverman, MD, DSc;
Chandra Ramamoorthy, MB BS, FFA (UK);
Frandics P. Chan, MD
From the Division of Pediatric Cardiology, Department of Pediatrics (M.K.F., N.H.S.), Department of Pathology (I.L.C.), Department of Pediatric Cardiac Anesthesiology (C.R.), and Department of Radiology (F.P.C.), Lucile Packard Children’s Hospital at Stanford and Stanford University, Stanford, Calif.
Correspondence to Mark Friedberg, MD, Division of Pediatric Cardiology, 750 Welch Rd, Suite #305, Palo Alto, CA, 94304. E-mail mark.friedberg{at}stanford.edu
A previously healthy 13-year-old boy collapsed at home. The emergency medical service diagnosed ventricular tachycardia and cardioverted to sinus rhythm. The left cardiac contour was abnormal on radiography (Figure 1). Echocardiography showed a large mass at the lateral mitral annulus (Figure 2), without impediment to valvar function or blood flow. Magnetic resonance imaging (MRI) confirmed an encapsulated, homogenous, 5x4x5-cm mass, embedded in the myocardium, adjacent to but not involving the circumflex coronary artery. This mass had hyperintense MRI T1-weighted signal (Figure 3A) that was suppressed by fat suppression (Figure 3B), consistent with lipoma or liposarcoma. The tumor was surgically excised (Figure 4A and Figure 4B); the left ventricular posterior wall was reconstructed, and an internal cardioverter-defibrillator was placed. Histology confirmed the diagnosis of lipoma (Figure 5).
View larger version (156K):
[in this window]
[in a new window]
|
Figure 1. Chest radiograph in anterior-posterior projection shows an abnormal left cardiac border (arrow) at the level of the left hilum, characterized by a relatively radiolucent convex contour, suggesting an underlying mass.
|
|
View larger version (139K):
[in this window]
[in a new window]
|
Figure 2. Transthoracic echocardiogram in the apical 4-chamber view, demonstrating a large mass (arrow) at the lateral mitral annulus.
|
|
View larger version (77K):
[in this window]
[in a new window]
|
Figure 3. A, T1-weighted, double-inversion recovery magnetic resonance image in the parasagittal plane shows a 2-chamber, long-axis view of the left ventricle. T1-hyperintense mass (arrow) is seen embedded within the anterior wall, closely related to but separated from the mitral annulus. Cross section of the left circumflex artery (arrowhead) is seen in the adjacent atrioventricular groove. B, Fat-suppressed triple inversion-recovery MRI in an identical long-axis view shows complete suppression of the T1 signal in the mass. The signal characteristics are compatible with a fat-containing tumor.
|
|
View larger version (97K):
[in this window]
[in a new window]
|
Figure 4. A, Surgical excision of the intramural tumor (arrow) through a left ventriculotomy. B, Gross pathology of the tumor after excision. The tumor measured 6x4x4.5 cm and had a white-yellow fatty appearance and a rubber-like consistency.
|
|
View larger version (154K):
[in this window]
[in a new window]
|
Figure 5. Histological section shows mature adipose tissue intermixed with myocardium, consistent with cardiac lipoma (hematoxylin and eosin stain; magnification x20).
|
|
Childhood cardiac tumors are rare but can cause life-threatening arrhythmias, obstruction to blood flow, and valvar or myocardial dysfunction. Rhabdomyomas, the most common tumor in childhood, may regress spontaneously. Fibromas and lipomas, on the other hand, often require surgery or heart transplantation if the tumor erodes through the myocardium.
 |
Acknowledgments
|
|---|
Dr Friedberg is a Glaser Pediatric Research Network Fellow.
Source of Funding
Dr Friedberg is supported by a Glaser Pediatric Research Network Fellowship.
Disclosures
None.
Related Article:
-
Issue Highlights
Circulation 2006 113: 2473.
[Full Text]
