Lipomatous Hypertrophy of the Interatrial Septum

A Prospective Study of Incidence, Imaging Findings, and Clinical Symptoms

      Background

      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.

      Objectives

      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.

      Results

      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.

      Conclusions

      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.

      Key words

      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
      Subscribe to CHEST
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Shirani J
        • Roberts WC
        Clinical, electrocardiographic and morphologic features of massive fatty deposits (“lipomatous hypertrophy”) in the atrial septum.
        J Am Coll Cardiol. 1993; 22: 226-238
        • Burke AP
        • Litovsky S
        • Virmani R
        Lipomatous hypertrophy of the atrial septum presenting as a right atrial mass.
        Am J Surg Pathol. 1996; 20: 678-685
        • Beau P
        • Michel P
        • Coisne D
        • et al.
        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
        • Simons M
        • Cabin HS
        • Jaffe CC
        Lipomatous hypertrophy of the atrial septum: diagnosis by combined echocardiography and computerized tomography.
        Am J Cardiol. 1985; 54: 465-466
        • Fyke III, FE
        • Tajik AJ
        • Edwards WD
        • et al.
        Diagnosis of lipomatous hypertrophy of the atrial septum by two-dimensional echocardiography.
        J Am Coll Cardiol. 1983; 1: 1352-1357
        • Silverman PM
        • Guadalajara JF
        • Kisslo JA
        • et al.
        Lipomatous hypertrophy of the atrial septum: diagnosis by combined two-dimensional echocardiography and computerized tomography.
        Am J Cardiol. 1984; 54: 1156-1157
        • Südfeld F
        • Saul F
        • Hufnagel B
        • et al.
        Lipomatöse hypertrophie des interatrialen septums.
        Z Kardiol. 2000; 89: 587-591
        • Isner JM
        • Swan II, CS
        • Mikus JP
        • et al.
        Lipomatous hypertrophy of the interatrial septum: in vivo diagnosis.
        Circulation. 1982; 66: 470-473
        • Dooms GC
        • Hricak H
        • Sollito RA
        • et al.
        Lipomatous tumors and tumors with fatty components: MR imaging potential and comparison of MR and CT results.
        Radiology. 1985; 157: 479-483
        • Lund JT
        • Ehrman RL
        • Julsrud PR
        • et al.
        Cardiac masses: assessment by MR imaging.
        AJR Am J Roentgenol. 1989; 152: 469-473
        • Fisher MS
        • Edmonds PR
        Lipomatous hypertrophy of the interatrial septum: diagnosis by magnetic resonance imaging.
        J Comput Tomogr. 1988; 12: 267-269
        • Kaplan KR
        • Rifkin MD
        MR diagnosis of lipomatous hypertrophy of the interatrial septum.
        AJR Am J Roentgenol. 1989; 153: 495-496
        • Meaney JFM
        • Kazerooni EA
        • Jamadar DA
        • et al.
        CT appearance of lipomatous hypertrophy of the interatrial septum.
        AJR Am J Roentgenol. 1997; 168: 1081-1084
        • Gay JD
        • Guileyardo JM
        • Townsend-Parchman JK
        • et al.
        Clinical and morphologic features of lipomatous hypertrophy (“massive fatty deposits”) of the interatrial septum.
        Am J Forensic Med Pathol. 1996; 18: 107-108
        • Inoue T
        • Mohri N
        • Nagahara T
        • et al.
        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
        • Prior JT
        Lipomatous hypertrophy of cardiac interatrial septum.
        Arch Pathol. 1964; 78: 11-15
        • O'Rahilly R
        • Muller F
        The cardiovascular and lymphatic systems.
        in: O'Rahilly R Muller F Human embryology and teratology. Wiley, New York, NY1992: 107-135
        • Reyes CV
        • Jablokow VR
        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
        • Pochis WT
        • Saeian K
        • Sagar KB
        Usefulness of transesophageal echocardiography in diagnosing lipomatous hypertrophy of the atrial septum with comparison to transthoracic echocardiography.
        Am J Cardiol. 1992; 70: 396-398
        • Kluge WF
        Lipomatous hypertrophy of the interatrial septum.
        Northwest Med. 1969; 68: 25-30
        • Köhler U
        • Bittinger A
        Lipomatöse hypertrophie des vorhofseptums: kardial bedingte synkope bei hamartom des rechten vorhofs.
        Dtsch Med Wochenschr. 1991; 116: 1393-1396
        • Colucci WS
        • Schoen FJ
        • Braunwald E
        Primary tumors of the heart.
        in: Braunwald E Heart disease. WB Saunders, Philadelphia, PA1997: 1464-1477
        • Hutter AM
        • Page DL
        Atrial arrhythmias and lipomatous hypertrophy of the cardiac interatrial septum.
        Am Heart J. 1971; 82: 16-21
        • Erhardt LR
        Abnormal electrical activity in lipomatous hypertrophy of the interatrial septum.
        Am Heart J. 1974; 87: 571-576
        • McAllister HA
        • Fenoglio JJ
        Atlas of tumor pathology. Armed Forces Institute of Pathology, Washington, DC1978
        • Novick RJ
        • Dobell ARC
        Tumors of the heart.
        in: Baue EA Thoracic and cardiovascular surgery. 5th ed. Appleton and Lange, East Norwalk, CT1991: 1989-2002
        • Dotti MT
        • Mondillo S
        • Plewnia K
        • et al.
        Cerebrotendinous xanthomatosis: evidence of lipomatous hypertrophy of the right atrium.
        J Neurol. 1998; 245: 723-726
        • Vaughan CJ
        • Weremowicz S
        • Goldstein MM
        • et al.
        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
        • Enzi G
        • Busetto L
        • Ceschin E
        • et al.
        Multiple symmetric lipomatosis: clinical aspects and outcome in a long-term longitudinal study.
        Int J Obes Relat Metab Disord. 2002; 26: 253-261
        • Christiansen S
        • Stypmann J
        • Baba HA
        • et al.
        Surgical management of extensive lipomatous hypertrophy of the right atrium.
        Cardiovasc Surg. 2000; 8: 88-90
        • McNamara RF
        • Taylor AE
        • Panner BJ
        Superior vena caval obstruction by lipomatous hypertrophy of the right atrium.
        Clin Cardiol. 1987; 10: 609-610
        • Wann LS
        • Sampson C
        • Liu Y
        Cardiac and paracardiac masses: complementary role of echocardiography and magnetic resonance imaging.
        Echocardiography. 1998; 15: 139-146
        • Mortele KJ
        • Mergo PJ
        • Williams WF
        Lipomatous hypertrophy of the atrial septum: diagnosis with suppressed MR imaging.
        J Magn Reson Imaging. 1998; 8: 1172-1174