The lesion can be confused for a tumour on echocardiography for an intracardiac or atrial septal echogenic mass although the fat attenuation at CT or fat suppression on MRI images is diagnostic. In practice I find the preservation of the fossa ovalis as an anatomic landmark for determining the location of any patent foramen ovale (in acute right cardiac strain due to pulmonary embolism or pulmonary hypertension) or locating a atrial septal defect can be helpful. In my experience extension of generalised fat into the epicaridal space is demonstrated in some cases. On one occasion, I recall the interatrial lipomatous hypertrophy acting as a pathway for extension of pericardial malignant disease infiltration.
Case to Ponder 52 Answer: Lipomatous Hypertrophy of the Interatrial Septum - “Interatrial Lipoma”.27/1/2016 The CT images demonstrate a low density fatty proliferation within the interatrial septum. This has a typical dumbbell configuration, with a central stalk reflecting the fossa ovalis. This is the typical appearance of Lipomatous Hypertrophy of the Interatrial Septum (LHAS). This is sometimes referred to as an “interatrial lipoma” although it is unclear that such a distinct entity exists in this location as opposed to elsewhere in the heart and pericardium. The finding is generally an incidental finding and as in this case asymptomatic. There have been reports of possible associations with supraventricular tachycardias although it is unclear that these are not coincidental. Isolated cases of superior vena cava obstruction due to very large lesions have also been described. The incidence is unclear as the finding is under-recognised and due to limited clinical significance under-reported. An incidence of up to 1% appears more reasonable than some published estimates of 2-8%. Although there are some associations with generalised obesity these are not consistently present.
The lesion can be confused for a tumour on echocardiography for an intracardiac or atrial septal echogenic mass although the fat attenuation at CT or fat suppression on MRI images is diagnostic. In practice I find the preservation of the fossa ovalis as an anatomic landmark for determining the location of any patent foramen ovale (in acute right cardiac strain due to pulmonary embolism or pulmonary hypertension) or locating a atrial septal defect can be helpful. In my experience extension of generalised fat into the epicaridal space is demonstrated in some cases. On one occasion, I recall the interatrial lipomatous hypertrophy acting as a pathway for extension of pericardial malignant disease infiltration.
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