Thoracoscopic relief of symptomatic lipomatous hypertrophy
of atrial septum.
We read the outstanding article by Miller and Tazelaar1 recently published in the Archives of Pathology & Laboratory Medicine about the main features of 5 cardiovascular pseudoneoplasms (inflammatory myofibroblastic tumor, hamartoma of mature cardiac myocytes, mesothelial monocytic cardiac excrescences, calcified amorphous tumor, and lipomatous hypertrophy
of the atrial septum).
After those findings on TTE, we decided to perform a transesophageal echocardiography (TEE), which showed "dumbbell-shape" image, a very typical image for lipomatous hypertrophy (Fig.
Although lipomatous hypertrophy of interatrial septum has been known since 1960's, its pathophysiology is still unclear.
This section focuses on 5 reactive and "pseudoneoplastic" tumors of the heart, which mimic true neoplasms either grossly (including by clinical imaging) or microscopically, and include (1) inflammatory myofibroblastic tumor (IMT), (2) hamartoma of mature cardiac myocytes (HMCM), (3) mesothelial/monocytic incidental cardiac excrescences (MICE), (4) calcified amorphous tumor (CAT), and (5) lipomatous hypertrophy of the atrial septum (LHAS).
Lipomatous hypertrophy of the atrial septum, like CAT, is another lesion rarely mistaken for malignancy, histologically, but is of clinical significance owing to the frequent echocardiographic appearance of a mass protruding into the right atrium.
Lipomatous hypertrophy of the atrial septum is a process involving the limbus of the fossa ovalis, a structure representing the embryologic septum secundum.
Lipomatous hypertrophy of the interatrial septum (LHAS), characterized with lipid deposition in the interatrial septum, is thought to be benign and rarely associated with clinical manifestations.
We performed transesophageal echocardiography for the detection of the nature of this mass and it showed lipomatous hypertrophy of the interatrial septum (Fig.
Video 1: Three-dimensional transesophageal echocardiography (3D TEE) features of lipomatous hypertrophy of the interatrial septum.
Pathologic examination of the specimen revealed the typical pattern of lipomatous hypertrophy with large accumulation of adipose tissue (Fig.
This is the first case reporting the combination of ascending aortic aneurysm and lipomatous hypertrophy.