Right atrial lipomatous hypertrophy: A Case Report

Background The lipomatous hypertrophy in the atrial septum (LHAS) is a separate non-neoplastic benign cardiac lesion. It presents as a non-encapsulated fat deposit in the epicardium of the septum secundum which spreads excessively in the intraartial septum except the fossa ovalis and shows the typical hourglass-shaped image, with a tendency to bulge into the right atrium which may be related with a thickening of crista terminalis. The septum thickness can reach more than 20 mm and also accumulate in the subepicardium, endocardium, mediastinum and crista terminalis. This is most frequently seen in obese, elderly female patients. Complications of LHAS are severe cardiac arrhythmias (sick sinus syndrome, arrhythmias, changes in P waveform morphology in electrocardiogram (ECG)), vena cava superior syndrome, heart failure, pericardial effusion and sudden cardiac death requiring an urgent cardiovascular surgery. Case presentation We report about a 78-year-old female patient with a two-vessel coronary artery disease (CAD) with 50% of the circumflex artery (CX) and 60% stenosis of the right coronary artery (RCA) and a tumor mass in the right atrium with unclear dignity. Also, she had atrial fibrillation and massive supra ventricular extrasysoles. She received a reduction of the tumor mass with an atrial xenopericardial patch plastic, an enlargement of the superior vena cava and an aorta coronary bypass (ACBP) to the RCA. Conclusion The LHAS is a rare and benign mass, possibly causing atrial arrhythmias depending of the location. It can also be quite challenging to access the heart cavities and can cause many complications, like mitral or tricuspid regurgitation, stenosis or septal defects.