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(Circulation. 2001;103:1485.)
© 2001 American Heart Association, Inc.

Images in Cardiovascular Medicine

Ventricular Lipoma Detection by Magnetic Resonance Imaging

C. R. Comeau, BS, RT; A. D. Berke, MD; S. D. Wolff, MD, PhD

From the Cardiovascular Research Foundation and the Lenox Hill Heart and Vascular Institute, New York (C.R.C., S.D.W.), and St Francis Hospital, Roslyn, NY (A.D.B.).

Correspondence to Steven D. Wolff, MD, PhD, Cardiovascular Research Foundation, 55 East 59th Street, 6th Floor, New York, NY 10021. E-mail swolff@lenoxhill.net

During a routine physical examination, a 37-year-old woman was noted to have a heart murmur. Her physician ordered a transthoracic echocardiogram for the presumptive diagnosis of mitral valve prolapse. Instead, the study showed a mass in the anterior wall of the left ventricle (Figure 1), with a question of a second mass involving the posterior papillary muscle. A transesophageal echocardiogram was performed, which again showed an anterior wall mass (Figure 2). The patient was scheduled for surgery to resect the mass; however, she requested a second opinion. A cardiac catheterization was performed, demonstrating normal right and left heart filling pressures, normal ventricular function, no significant coronary artery disease, and no abnormal neovascularization in the left ventricular chamber. A MRI was ordered for further evaluation.

View larger version (126K): [in this window] [in a new window]   Figure 1. Transthoracic echocardiogram showing echogenic mass involving anterior wall of left ventricle (arrow).

View larger version (154K): [in this window] [in a new window]   Figure 2. Transesophageal echocardiogram showing short-axis view of mass adjacent to anterior papillary muscle (arrow).

Cardiac MRI showed a solitary, sharply marginated, bilobed mass arising from the endocardial surface of the left ventricle (Figure 3). No other masses were present. Regional wall motion near the mass was normal. The signal intensity of the mass was consistent with fat on several pulse sequences (Figures 3 and 4). First-pass perfusion imaging with MRI showed the mass was poorly perfused relative to normal myocardium (Figure 5).

View larger version (79K): [in this window] [in a new window]   Figure 3. Cardiac cine images acquired with fat and water out-of-phase (A) and in-phase (B). Each lobe measures 12x3 mm. Mass has much lower signal intensity on out-of-phase . . . [Full Text of this Article]