Near Sudden Death From Cardiac Lipoma in an Adolescent
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, 5×4×5-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).
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.
Dr Friedberg is a Glaser Pediatric Research Network Fellow.
Source of Funding
Dr Friedberg is supported by a Glaser Pediatric Research Network Fellowship.