Title: Left Ventricular Asynchrony Caused by an Intramuscular Lipoma
Abstract: HomeCirculationVol. 107, No. 21Left Ventricular Asynchrony Caused by an Intramuscular Lipoma Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplementary MaterialsFree AccessReview ArticlePDF/EPUBLeft Ventricular Asynchrony Caused by an Intramuscular LipomaComputed Tomographic and Magnetic Resonance Detection Naotsugu Oyama, MD, Noriko Oyama, MD, Hiroshi Komatsu, MD, Koichi Okita, MD, Kazuya Yonezawa, MD, Satoshi Fujii, MD, Kazuo Miyasaka, MD and Akira Kitabatake, MD Naotsugu OyamaNaotsugu Oyama From the Department of Cardiovascular Medicine (Naotsugu Oyama, H.K., K.O., K.Y., S.F., A.K.) and Department of Radiology (Noriko Oyama, K.M.), Hokkaido University Graduate School of Medicine, Sapporo, Japan. Search for more papers by this author , Noriko OyamaNoriko Oyama From the Department of Cardiovascular Medicine (Naotsugu Oyama, H.K., K.O., K.Y., S.F., A.K.) and Department of Radiology (Noriko Oyama, K.M.), Hokkaido University Graduate School of Medicine, Sapporo, Japan. Search for more papers by this author , Hiroshi KomatsuHiroshi Komatsu From the Department of Cardiovascular Medicine (Naotsugu Oyama, H.K., K.O., K.Y., S.F., A.K.) and Department of Radiology (Noriko Oyama, K.M.), Hokkaido University Graduate School of Medicine, Sapporo, Japan. Search for more papers by this author , Koichi OkitaKoichi Okita From the Department of Cardiovascular Medicine (Naotsugu Oyama, H.K., K.O., K.Y., S.F., A.K.) and Department of Radiology (Noriko Oyama, K.M.), Hokkaido University Graduate School of Medicine, Sapporo, Japan. Search for more papers by this author , Kazuya YonezawaKazuya Yonezawa From the Department of Cardiovascular Medicine (Naotsugu Oyama, H.K., K.O., K.Y., S.F., A.K.) and Department of Radiology (Noriko Oyama, K.M.), Hokkaido University Graduate School of Medicine, Sapporo, Japan. Search for more papers by this author , Satoshi FujiiSatoshi Fujii From the Department of Cardiovascular Medicine (Naotsugu Oyama, H.K., K.O., K.Y., S.F., A.K.) and Department of Radiology (Noriko Oyama, K.M.), Hokkaido University Graduate School of Medicine, Sapporo, Japan. Search for more papers by this author , Kazuo MiyasakaKazuo Miyasaka From the Department of Cardiovascular Medicine (Naotsugu Oyama, H.K., K.O., K.Y., S.F., A.K.) and Department of Radiology (Noriko Oyama, K.M.), Hokkaido University Graduate School of Medicine, Sapporo, Japan. Search for more papers by this author and Akira KitabatakeAkira Kitabatake From the Department of Cardiovascular Medicine (Naotsugu Oyama, H.K., K.O., K.Y., S.F., A.K.) and Department of Radiology (Noriko Oyama, K.M.), Hokkaido University Graduate School of Medicine, Sapporo, Japan. Search for more papers by this author Originally published3 Jun 2003https://doi.org/10.1161/01.CIR.0000062401.65951.B4Circulation. 2003;107:e200–e201Routine chest x-ray of a 67-year-old woman revealed a mass contiguous with the cardiac silhouette. Echocardiogram located the mass in the anterior wall of the left ventricle. Magnetic resonance (MR) and computed tomography (CT) imaging showed a solitary mass with a clear margin resembling a balloon arising from myocardium of the left ventricle (Figure 1; Figure 2A and 2B). The mass extended from the left ventricular myocardium to the epicardial space. On CT, the nonenhanced mass showed low density with a mean CT value of -120 Hounsfield units (HU), which was compatible with fat. In cardiac MR imaging, the signal intensity of the mass on several pulse sequences was consistent with that of fat (Figure 2A and 2B and Figure 3). For kinetic analysis of the left ventricular wall, cine MR imaging was done. This revealed asynchronic motion of the left ventricle due to the tumor (Movies I and II). The tumor contracted just after the systolic phase of the left ventricle. During contraction, the tumor was first pushed out and appeared constricted just after contraction. On the basis of CT and MR imaging, the lesion was thought to represent a lipoma arising within the myocardium with paracardiac extension. The inner myocardium of the mass was very thin, and surgical debulking was not considered an appropriate option because of the possibility of cardiac rupture. Download figureDownload PowerPointFigure 1. Contrast-enhanced CT with ECG trigger shows a low-density tumor arising from the anterior wall of the left ventricle without enhanced lesions. The mean CT value of the mass is −120 HU, and it is composed of fat only.Download figureDownload PowerPointFigure 2. Cardiac-gated T1-weighted spin echo MR image (repetition time/echo time [both in milliseconds]=898/20) in long-axis plane (A) and cine gradient echo MR sequence (repetition time/echo time=100/5; flip angle=20) in short-axis plane (B) show a clearly margined mass, moving asynchronically. The mass extends from the left ventricular myocardium to the epicardial space.Download figureDownload PowerPointFigure 3. Cardiac-gated standard T1-weighted spin echo MR image (repetition time/echo time=898/20) with free breathing in the axial plane shows a balloon-shaped tumor involving the left ventricular anterior wall. The tumor extends from myocardium into the pericardial space. The tumor had a markedly hyperintense signal on T1-weighted standard spin echo, similar to the signal intensity from the subcutaneous fat.*Drs Naotsugu Oyama and Noriko Oyama contributed equally to this article.Movies I and II are available in the online-only Data Supplement at http://www.circulationaha.org.The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.FootnotesCorrespondence to Satoshi Fujii, MD, Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo 060-8638, Japan. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited By Bai R, Zhang Y, Wang H, Yang J and Sun D (2020) Invasive cardiac lipoma diagnosis based on echocardiography: Case report and literature review, Journal of Clinical Ultrasound, 10.1002/jcu.22893, 49:4, (408-412), Online publication date: 1-May-2021. Sun X, Liu G, Kim H and Sun W (2018) Left ventricular lipoma resected using thoracoscope-assisted limited sternotomy, Medicine, 10.1097/MD.0000000000011436, 97:31, (e11436), Online publication date: 1-Aug-2018. Hayashi H, Hidaka F, Kiriyama T, Sato H, Takagi R and Kumita S (2008) A left ventricular lipoma diagnosed on three-dimensional electrocardiogram-gated cardiac computed tomography, Heart and Vessels, 10.1007/s00380-007-1037-2, 23:5, (366-369), Online publication date: 1-Sep-2008. Korantzopoulos P, Patsouras D, Kountouris E, Voukelatou M, Charaktsis I, Zakkas F and Siogas K (2016) Lipoma of the Interatrial Septum in a Patient With Chronic Atrial Fibrillation, Angiology, 10.1177/0003319706290738, 57:4, (513-516), Online publication date: 1-Aug-2006. Bogaert J and Dymarkowski S Cardiac Masses Clinical Cardiac MRI, 10.1007/3-540-26997-5_12, (305-351) NK S (2017) Anatomical Distribution of Intramuscular Lipomas, Journal of Forensic Science and Research, 10.29328/journal.jfsr.1001004, 1:1, (035-039) June 3, 2003Vol 107, Issue 21 Advertisement Article InformationMetrics https://doi.org/10.1161/01.CIR.0000062401.65951.B4PMID: 12782618 Originally publishedJune 3, 2003 PDF download Advertisement