key: cord-0789767-goe812fc authors: Casado-Arroyo, Rubén; Vidal-Perez, Rafael; Maeda, Shingo title: Gaining Insights Into Lipomatous Hypertrophy of the Interatrial Septum: A Step Forward date: 2020-11-18 journal: JACC Case Rep DOI: 10.1016/j.jaccas.2020.10.007 sha: 5fc1eab98cd5a704c22ce7b8637a4cb560584d04 doc_id: 789767 cord_uid: goe812fc [Figure: see text] Cardiac tumors can be classified as primary or metastatic, with metastatic tumors almost 20 times more common in clinical practice than primary tumors. Of these cardiac tumors, 80% of primary tumors are benign, and 20% are malignant, with an incidence of <0.03% at necropsy (2) . Metastatic Fatty infiltration of the atrial septum, preserving the fossa ovalis. "Dumbbell-shaped" mass involving the interatrial septum with sparing of the fossa ovalis, homogenous appearance with sharp margins, fatty attenuation (density<-50 HU), and no or minimal contrast enhancement. Nonencapsulated, immobile, hyperintense mass, without stalk. No uptake after contrast enhancement. Homogenous, low attenuation, minimal enhancement, central calcification. Demarcated, noncontractile and solid, highly echogenic mass. No enhancement with contrast. Hypo/isointense, solitary, noncontractile mass that often narrows the ventricular cavity. Hyperenhancement after contrast Enhancement. Heterogeneous mobile mass pedunculated in the region of the fossa ovalis. Partially enhanced with contrast. Pedunculated, mobile, heterogeneous, low attenuation, 10% calcified. Hypointense, mobile. Heterogeneous after contrast enhancement. Smooth, encapsulated, fat attenuation, no enhancement. Homogeneous, broad-based, immobile, without a pedicle and encapsulated; most often small in size. No enhancement with contrast. Arise from the epicardium or endocardium; when originates from the endocardium, it manifests decreased mobility and a broad base of attachment. No uptake after contrast enhancement. Smooth, multiple, attenuation similar to myocardium. Small, well-circumscribed (multiple) nodules or a pedunculated mass. No enhancement with contrast. Multiple well circumscribed and vary from a few mm to a few cm in size. No/minimal uptake after contrast enhancement. Broad base, irregular, heterogeneous, low attenuation, infiltrative, pericardial effusion, Lobulated masses, distinctly heterogeneous with an area of necrosis or hemorrhage. Hyperenhancement with contrast. Isointense. Heterogeneous uptake after contrast enhancement. Irregular, low attenuation, infiltrative. Arise from any cardiac structure, initially invade the pericardium. Hyperenhancement with contrast. Isointense that involves multiple sites within the heart, including the valves. Homogeneous uptake after contrast enhancement. Large, fat and soft tissue attenuation, mild contrast enhancement, infiltrative. Broad-based mass, with heterogeneous echogenicity. Hyperenhancement with contrast. Isointense mass. Heterogeneous after contrast enhancement. Typically demonstrates thickening and nodularity. Often demonstrate enhancement. Homogeneous, infiltrating masses leading to wall thickening or as nodular masses. Hyperenhancement with contrast. Isointense, pericardial effusion. No/ minimal uptake after contrast enhancement. Pericardial metastasis can appear as pericardial thickening, disruption, or effusion. Often demonstrate enhancement. The pericardium is more frequently involved with metastases. Pericardial effusion. Hyperenhancement with contrast. Typical involvement is the pericardium. Heterogeneous after contrast enhancement. Hypodense, low attenuation filling defect in a contrast pool within a cardiac chamber. Chronic thrombi may develop spotty calcifications. Variable size. May be homogeneously echogenic or may have heterogeneous texture with lucent areas. No enhancement with contrast. Isointense/ hypointense mass (if recent thrombus). Typically localized near a wall motion abnormality (after infarction) or in the left atrial appendage. No uptake after contrast enhancement. Thin-walled structures sharply demarcated, homogenous appearance, attenuation similar to water (-10 to 20 HU). Nonenhancing lesions with contrast. Echolucent mass adjoining the cardiac border. Frequently septated. No enhancement with contrast. Encapsulated fluid-filled structure typically located in the right pericardiophrenic angle. Frequency of primary tumors of the heart Primary cardiac tumors: experience at the University of Minnesota Differentiating benign from malignant cardiac tumors with cardiac magnetic resonance imaging Lipomatous hypertrophy of the interatrial septum Lipomatous hypertrophy of the interatrial septum manifesting as third degree atrioventricular block Lipomatous hypertrophy of cardiac interatrial septum. A lesion resembling hibernoma, lipoblastomatosis and infiltring lipoma Lipomatous hypertrophy of the interatrial septum: in vivo diagnosis Lipomatous hypertrophy of the interatrial septum: a pathological and clinical approach Molecular basis of atrial fibrillation pathophysiology and therapy: a translational perspective