Multiple Left Ventricular Cardiac Lipomas Involving Papillary Muscle: Role of Multimodality Imaging and Surgical Management

A 36-year-old female with bronchial asthma presented with exertional dyspnea (New York Heart Association Class II). She had a prior transient ischemic attack (TIA), prompting cardiovascular evaluation. Transthoracic echocardiography revealed multiple intracardiac masses. Cardiac computed tomography and magnetic resonance imaging demonstrated multiple distinct lipomas involving the left ventricular cavity and both papillary muscles, showing imaging features consistent with benign lipomatous tumors without myocardial invasion or malignant characteristics. Following the exclusion of other embolic sources, the TIA was considered cryptogenic. The patient underwent successful surgical excision with mitral valve replacement due to subvalvular structural involvement. Histopathology confirmed multiple cardiac lipomas. The postoperative course was uneventful. This case highlights the rare occurrence of multiple cardiac lipomas and the importance of multimodality imaging in diagnosis, differentiation from malignant lesions, and surgical planning.