Gopal Dipika J, Han Yuchi, Silvestry Frank E, Ferrari Victor A
Department of Cardiology, Perelman Center for Advanced Medicine, East Pavilion, 2nd Floor, 3400 Civic Center Boulevard, University of Pennsylvania, Philadelphia, PA 19104, USA.
Eur Heart J Case Rep. 2019 Nov 11;3(4):1-4. doi: 10.1093/ehjcr/ytz202. eCollection 2019 Dec.
Lipomatous hypertrophy of the interatrial septum (LHIAS) is a common finding on transthoracic echocardiogram (TTE). Occasionally, the appearance of LHIAS is atypical and multimodality imaging is helpful to make the diagnosis. We present a case of atypical LHIAS to highlight the potential aetiologies for an interatrial septal mass and review features on multimodality imaging that help decrease uncertainty and establish a diagnosis.
A 64-year-old man with a history of hypertension, diabetes mellitus, and coronary artery disease with multiple percutaneous coronary interventions presented to the emergency room with chest pain. Transthoracic echocardiogram showed a homogenous echo-dense, intracardiac mass present within the interatrial septum. Computed tomography (CT) angiogram of the chest showed a homogenous mass similar in radiodensity to extracardiac and pericardial fat. Cardiac magnetic resonance (CMR) confirmed LHIAS by homogenous signal that was nulled on fat suppression images.
This case highlights that while most LHIAS has the standard 'dumbbell' appearance on TTE, there are instances where it can appear more like an adherent mass prompting a wider differential. Unenhanced CT of the heart can be used to confirm LHIAS by the presence of low attenuation values for tissue. Alternatively, CMR can be used for tissue characterization and confirmation of LHIAS. Precontrast T2/T1-weighted CMR images with steady-state free precession show high signal intensity in the area of LHIAS and produce a black/hypointense boundary effect between fat and myocardium. A multimodality approach is crucial in arriving at the appropriate diagnosis using the tissue characterization capabilities of CT and CMR.
房间隔脂肪肥厚（LHIAS）是经胸超声心动图（TTE）常见的表现。偶尔，LHIAS的表现不典型，多模态成像有助于诊断。我们报告一例不典型LHIAS病例，以强调房间隔肿块的潜在病因，并回顾多模态成像的特征，这些特征有助于减少不确定性并确立诊断。
一名64岁男性，有高血压、糖尿病和冠状动脉疾病史，曾多次接受经皮冠状动脉介入治疗，因胸痛就诊于急诊室。经胸超声心动图显示房间隔内有一个均匀的回声密集的心内肿块。胸部计算机断层扫描（CT）血管造影显示一个均匀的肿块，其放射密度与心外和心包脂肪相似。心脏磁共振成像（CMR）通过脂肪抑制图像上均匀的信号证实为LHIAS。
该病例强调，虽然大多数LHIAS在TTE上具有标准的“哑铃”外观，但在某些情况下，它可能更像是一个附着的肿块，从而导致更广泛的鉴别诊断。心脏非增强CT可通过组织的低衰减值来确认LHIAS。或者，CMR可用于组织特征分析和LHIAS的确认。具有稳态自由进动的对比前T2/T1加权CMR图像在LHIAS区域显示高信号强度，并在脂肪和心肌之间产生黑色/低信号边界效应。利用CT和CMR的组织特征分析能力，多模态方法对于做出正确诊断至关重要。
