Lipomatous hypertrophy of the interatrial septum (LHIS) is a benign disorder characterized by fat accumulation in the interatrial septum. It typically occurs in elderly, obese patients and may cause arrhythmia.
The purpose of this study was to determine the imaging features of this cardiac pathology using multislice CT (MSCT), and its relationship with clinical findings.
Materials and methods
A total of 1,292 consecutive patients who underwent MSCT of the thorax from September 2001 to August 2002 were prospectively studied. Beside the analysis of patient records, the amount of fat in the interatrial septum, and its size and shape were determined.
Among the 1,292 patients investigated, we found 28 (2.2%) with LHIS. The mean age of affected patients was 72.2 years. MSCT studies revealed a mass of fat attenuation with sharp margins and sparing of the fossa ovalis, resulting in a dumbbell shape in all patients. The median thickness of the interatrial septum was 32 mm (range, 20 to 62 mm), and the median craniocaudal extend was 62 mm (range, 51 to 89 mm). Twenty-one patients (75.0%) showed increased epicardial fat, 18 patients (64.3%) had significant pulmonary emphysema, and 13 of 21 patients (61.9%) showed ECG abnormalities. Three patients underwent functional cardiac MRI studies. In one patient, hemodynamic obstruction by LHIS was shown.
MSCT scanning is a useful method to diagnose LHIS, a cardiac condition that in our series reached a 2.2% incidence. The lesion shows characteristic features, thus differentiating it from other cardiac tumors. Advanced age, obesity, pulmonary emphysema, and atrial arrhythmias are common additional findings in patients with LHIS.
Abbreviations:BMI ( body mass index), LHIS ( lipomatous hypertrophy of the interatrial septum), MSCT ( multislice CT), 3-D ( three-dimensional)
To read this article in full you will need to make a payment
- Clinical, electrocardiographic and morphologic features of massive fatty deposits (“lipomatous hypertrophy”) in the atrial septum.J Am Coll Cardiol. 1993; 22: 226-238
- Lipomatous hypertrophy of the atrial septum presenting as a right atrial mass.Am J Surg Pathol. 1996; 20: 678-685
- Lipomatous hypertrophy of the cardiac interatrial septum: an unusual complication in long-term home parenteral nutrition in adult patients.JPEN J Parenter Enteral Nutr. 1991; 15: 659-662
- Lipomatous hypertrophy of the atrial septum: diagnosis by combined echocardiography and computerized tomography.Am J Cardiol. 1985; 54: 465-466
- Diagnosis of lipomatous hypertrophy of the atrial septum by two-dimensional echocardiography.J Am Coll Cardiol. 1983; 1: 1352-1357
- Lipomatous hypertrophy of the atrial septum: diagnosis by combined two-dimensional echocardiography and computerized tomography.Am J Cardiol. 1984; 54: 1156-1157
- Lipomatöse hypertrophie des interatrialen septums.Z Kardiol. 2000; 89: 587-591
- Lipomatous hypertrophy of the interatrial septum: in vivo diagnosis.Circulation. 1982; 66: 470-473
- Lipomatous tumors and tumors with fatty components: MR imaging potential and comparison of MR and CT results.Radiology. 1985; 157: 479-483
- Cardiac masses: assessment by MR imaging.AJR Am J Roentgenol. 1989; 152: 469-473
- Lipomatous hypertrophy of the interatrial septum: diagnosis by magnetic resonance imaging.J Comput Tomogr. 1988; 12: 267-269
- MR diagnosis of lipomatous hypertrophy of the interatrial septum.AJR Am J Roentgenol. 1989; 153: 495-496
- CT appearance of lipomatous hypertrophy of the interatrial septum.AJR Am J Roentgenol. 1997; 168: 1081-1084
- Clinical and morphologic features of lipomatous hypertrophy (“massive fatty deposits”) of the interatrial septum.Am J Forensic Med Pathol. 1996; 18: 107-108
- A case report of “lipomatous hypertrophy of the cardiac interatrial septum”, with a proposal for a new term “lipomatous hamartoma of the cardiac atrial septum.”.Acta Pathol Jpn. 1988; 38: 1538-1539
- Lipomatous hypertrophy of cardiac interatrial septum.Arch Pathol. 1964; 78: 11-15
- The cardiovascular and lymphatic systems.in: O'Rahilly R Muller F Human embryology and teratology. Wiley, New York, NY1992: 107-135
- Lipomatous hypertrophy of the cardiac interatrial septum: a report of 38 cases and review of the literature.Am J Clin Pathol. 1979; 72: 785-788
- Usefulness of transesophageal echocardiography in diagnosing lipomatous hypertrophy of the atrial septum with comparison to transthoracic echocardiography.Am J Cardiol. 1992; 70: 396-398
- Lipomatous hypertrophy of the interatrial septum.Northwest Med. 1969; 68: 25-30
- Lipomatöse hypertrophie des vorhofseptums: kardial bedingte synkope bei hamartom des rechten vorhofs.Dtsch Med Wochenschr. 1991; 116: 1393-1396
- Primary tumors of the heart.in: Braunwald E Heart disease. WB Saunders, Philadelphia, PA1997: 1464-1477
- Atrial arrhythmias and lipomatous hypertrophy of the cardiac interatrial septum.Am Heart J. 1971; 82: 16-21
- Abnormal electrical activity in lipomatous hypertrophy of the interatrial septum.Am Heart J. 1974; 87: 571-576
- Atlas of tumor pathology. Armed Forces Institute of Pathology, Washington, DC1978
- Tumors of the heart.in: Baue EA Thoracic and cardiovascular surgery. 5th ed. Appleton and Lange, East Norwalk, CT1991: 1989-2002
- Cerebrotendinous xanthomatosis: evidence of lipomatous hypertrophy of the right atrium.J Neurol. 1998; 245: 723-726
- A t(2;19)(p13;p13.2) in a giant invasive cardiac lipoma from patient with multiple lipomatosis.Genes Chromosomes Cancer. 2000; 28: 133-137
- Multiple symmetric lipomatosis: clinical aspects and outcome in a long-term longitudinal study.Int J Obes Relat Metab Disord. 2002; 26: 253-261
- Surgical management of extensive lipomatous hypertrophy of the right atrium.Cardiovasc Surg. 2000; 8: 88-90
- Superior vena caval obstruction by lipomatous hypertrophy of the right atrium.Clin Cardiol. 1987; 10: 609-610
- Cardiac and paracardiac masses: complementary role of echocardiography and magnetic resonance imaging.Echocardiography. 1998; 15: 139-146
- Lipomatous hypertrophy of the atrial septum: diagnosis with suppressed MR imaging.J Magn Reson Imaging. 1998; 8: 1172-1174
Accepted: December 28, 2003
Received: November 12, 2003
© 2003 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.