Prof. Dr. C. C. Iliescu Emergency Institute for Cardiovascular Diseases, Bucharest, Romania.
Heart Surg Forum. 2020 Mar 16;23(2):E140-E142. doi: 10.1532/hsf.2933.
Lipomas are the most common type of soft tissue tumors. They mainly are located in subcutaneous tissue in the body, including the heart. The cardiac location of lipomas is rare, mostly asymptomatic, and can cause life-threatening complications by rapid growth. The clinical symptoms, when present, occur in evolution with the growth in size, depending upon the location and degree of invasion in the endocardium. We present the case of a 63-year-old male patient with a large intrapericardial lipoma with an unusual location, originating from the left atrial roof. The initial symptoms of the patient were shortness of breath, dizziness, and mild dyspnea. Transthoracic echocardiography (TTE) was the first line diagnosis method, followed by computed tomography (CT); both showed a large posterior intrapericardial mass. Resection of a 12/8/5 cm lipomatous tumor mass was performed via median sternotomy, under cardiopulmonary bypass (CPB) on the beating heart. Histopathologic examination revealed the presence of diffuse proliferation of large- and medium-sized mature adipocytes consistent with the diagnosis of pericardial lipoma. The patient was discharged at home on the seventh postoperative day, with a marked improvement of his clinical state and effort tolerance. He did not present evidence of recurrence at his 1-year follow up.
脂肪瘤是最常见的软组织肿瘤类型。它们主要位于身体的皮下组织中，包括心脏。心脏部位的脂肪瘤比较少见，大多无症状，但可能会因快速生长而导致危及生命的并发症。当存在临床症状时，这些症状会随着肿瘤大小的增长而演变，具体取决于在心内膜中的位置和侵犯程度。我们报告了一例 63 岁男性患者，他患有起源于左心房顶部的非常见位置的大型心包内脂肪瘤。该患者的初始症状为呼吸困难、头晕和轻度呼吸困难。经胸超声心动图（TTE）是一线诊断方法，随后进行计算机断层扫描（CT）；两者均显示心包内有一个大的后心包肿块。通过正中胸骨切开术，在体外循环（CPB）下于跳动的心脏上进行了 12/8/5 厘米脂肪瘤瘤块的切除术。组织病理学检查显示存在大、中型成熟脂肪细胞的弥漫性增殖，符合心包脂肪瘤的诊断。患者在术后第 7 天出院回家，其临床状态和活动耐量有明显改善。在 1 年的随访中，他没有复发的迹象。
