CASE 10507 Published on 16.12.2012

Pericardial lipoma

Section

Chest imaging

Case Type

Clinical Cases

Authors

Yousef Wirenfeldt Nielsen

University Hospital at Herlev,
Dept. of Radiology 54E2;
Herlev Ringvej 75
2730 Herlev, Denmark;
Email:ywnielsen@gmail.com

Patient

55 years, male

Categories

Area of Interest Kidney, Thorax ; Imaging Technique CT

Procedure Diagnostic procedure ; Special Focus Neoplasia ;

Show more Show less

Download as PDF Print Show related cases Notify admin

Clinical History

An otherwise healthy patient presented with macroscopic haematuria. A renal tumour was suspected and the patient was referred to the urology department.

Imaging Findings

Contrast-enhanced CT of thorax and abdomen was performed. A small tumour was seen in the cortex of the left kidney (Figure 1). The morphology of the tumour was suggestive of renal cell carcinoma. There was no involvement of the renal vein. No liver or lung metastases were detected. As an incidental finding a fat containing non-enhancing process (negative HU-values) was seen adjacent to the right and left atria (Figure 2a-c). The lesion was well-marginated without any solid components. There was no sign of tumour invasion into the atria. However, the lesion compressed the right atrium and was thought to represent a lipoma arising within the pericardial cavity.

Discussion

Primary tumours of the heart and pericardium are rare. Lipomas account for 10% of primary cardiac tumours [1]. Pericardial lipomas usually remain asymptomatic. Most are detected incidentally during autopsies or imaging procedures [2]. Very large pericardial lipomas can cause cardiac symptoms, owing to the space-occupying effect of the tumour within the pericardium [3]. Symptomatic pericardial lipomas should be resected.
Different imaging modalities such as CT, MRI and echocardiography can detect pericardial lipomas [1, 4]. On CT and MRI lipomas present as well-marginated lesions containing fat, as was seen in the present case. If solid areas are present inside the fatty lesion, malignant transformation should be ruled out.
Pericardial tumours may complicate coronary bypass surgery [4]. It is therefore important to report these benign lesions.

Differential Diagnosis List

Pericardial lipoma

Pericardial effuison

Liposarcoma

Final Diagnosis

Pericardial lipoma

References

[1] Puvaneswary M, Edwards JR, Bastian BC, Khatri SK. (2000) Pericardial lipoma: ultrasound, computed tomography and magnetic resonance imaging findings. Australas Radiol 44(3):321-4 (PMID: 10974728)

[2] Zwolinski R, Ammer A, Walczak A, Jaszewski R. (2010) Intrapericardial lipoma: diagnosed unexpectedly and resected during coronary artery bypass surgery. Interact Cardiovasc Thorac Surg 11(2):211-2 (PMID: 20442209)

[3] Bardakci H, Altintas G, Unal U, Kervan U, Arda K, Birincioglu L. (2008) Giant cardiac lipoma: report of a case. J Card Surg 23(3):254-6 (PMID: 18435643)

[4] Kosar F, Sincer I, Kuzucu A, Nisanoglu V, Gunen H. (2007) A case of a large intrapericardial lipoma occupying pericardial space: an unusual complication of a coronary artery bypass surgery. J Card Surg 22(5):427-9 (PMID: 17803584)

Case information