Lipomatous Hypertrophy of the Atrial Septum

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Fatty infiltration of the atrial septum with sparing of the membrane of the fossa ovalis.

Echocardiographic Criteria for Diagnosis

Bilobed appearance as in the above image.
Septal thickness of 15 mm or more.
Exclusion of other causes of atrial septal thickening, such as amyloidosis, surgical patches, tumors.

References

Maillet-Vioud C, Eicher JC, Falcon S, Delescaut M, Gomez MC, Cottin Y, Brunotte F, Brenot R, Louis P, Wolf JE. Lipomatous septal hypertrophy. Apropos of 3 cases.
Ann Cardiol Angeiol (Paris) 1994 Jun;43(6):328-30.
Lipomatous hypertrophy of the inter-atrial septum is characterised by fatty accumulation in the inter-atrial septum. Long unrecognised, it has been discovered anew by virtue of the use of transesophageal echocardiography. The authors report three cases, including one presenting as acute ischemia of the right lower limb. After studying the contribution of imaging techniques to its diagnosis, the authors consider the principal differential diagnoses of this condition.

Kozelj M, Angelski R, Pavcnik D. Lipomatous hypertrophy of the interatrial septum: diagnosis by echocardiography and magnetic resonance imaging. A case report.
Angiology 1995 Sep;46(9):863-6
Lipomatous hypertrophy of the interatrial septum is generally a benign abnormality characterized by deposition of adipose tissue in the interatrial septum, usually extending to the atrial wall and interventricular septum. It is most often detected as an incidental echocardiographic finding. Transesophageal echocardiography can provide additional details, but in this case magnetic resonance imaging proved superior to it in assessing the involvement of other cardiac structures.

Basu S, Folliguet T, Anselmo M, Greengart A, Sabado M, Cunningham JN Jr, Jacobowitz IJ. Lipomatous hypertrophy of the interatrial septum.
Cardiovasc Surg 1994 Apr;2(2):229-31
Lipomatous hypertrophy of the interatrial septum, a finding associated with obesity and advancing age, consists of accumulation of adipose tissue including fetal adipose tissue in the interatrial septum. It is a rare lesion of the heart and can reach notable size. A case is reported in which the diagnosis of lipomatous hypertrophy of the interatrial septum was established intraoperatively; the large bulk of the lipoma was such that it required major reconstruction of the interatrial septum and right and left atrial walls.

Zarauza MJ, Alonso F, Hidalgo M, Hernando JP, Oliva MJ, Zueco J, Martin Duran R, Ochoteco A. Lipomatous hypertrophy of the interatrial septum simulating an atrial mass in a patient with a pulmonary embolism: its diagnosis by transesophageal echocardiography and percutaneous biopsy.
Rev Esp Cardiol 1993 Nov;46(11):761-4
A case of lipomatous hypertrophy of the interatrial septum in a patient with a history of repeated pulmonary embolism is presented. Thickening of the interatrial septum mimicking the presence of a right atrial mass was evidenced by transthoracic and transesophageal echocardiography. Lipomatous hypertrophy was suspected. The diagnosis was confirmed by echo guided (transesophageal) percutaneous transvenous biopsy.

Huet R, Bertinchant JP, Nigond J, Stordeur JM, Moragues C, Wittenberg O, Ovtchinnikoff S, Metge L, Lopez FM, Hertault J. Lipomatous hypertrophy of the interatrial septum. Apropos of 3 cases and review of the literature.
Arch Mal Coeur Vaiss 1993 Feb;86(2):237-41
Lipomatous hypertrophy of the interatrial septum is characterized by an accumulation of fatty tissue in the interatrial septum. The authors report three cases, one presenting with sinus tachycardia and the other two being chance findings. Echocardiography associated with cardiac computerized tomography or magnetic resonance imaging usually confirms the diagnosis. In half the cases, supraventricular arrhythmias and suggestive P wave abnormalities are observed on the electrocardiogram. Transoesophageal echocardiography is demonstrates the massive forms which may obstruct flow from the superior vena cava into the right atrium. The authors observe a discrepancy between the prevalence of this condition in autopsy series (about 1%) and the small number of cases described at echocardiography, suggesting that the diagnosis is probably missed.

Shirani J, Roberts WC. Clinical, electrocardiographic and morphologic features of massive fatty deposits (lipomatous hypertrophy) in the atrial septum.
J Am Coll Cardiol 1993 Jul;22(1):226-38
This study examined the morphologic features and the clinical significance of massive fatty deposits in the atrial septum of the heart. BACKGROUND. Large deposits of adipose tissue in the atrial septum were first described in 1964 and have been referred to as lipomatous hypertrophy of the atrial septum. A relation between these fatty deposits and atrial arrhythmias has been suggested. METHODS. The thickness of the atrial septum cephalad to the fossa ovalis ranged from 1.5 to 6 cm in 91 patients and was greater than or = 2 cm in 80 patients. This report focuses primarily on the latter 80 patients. RESULTS. The thickness of the atrial septum in the 80 patients correlated with body weight and the thickness of the adipose tissue in the atrioventricular groove and that covering the right ventricle. In 53 patients (67%), one or more of the four major epicardial coronary arteries were narrowed more than 75% in cross-sectional area by atherosclerotic plaque. Atrial arrhythmias were present in 31 patients (40%). Patients with larger deposits of fat (atrial septal thickness greater than or = 3 cm) had a higher frequency of atrial arrhythmias (60% vs. 34%, p less than 0.01). The atrial septum was significantly thicker in patients with atrial arrhythmia compared with those without atrial arrhythmias (2.9 vs. 2.3 cm, p less than 0.01). Of the 28 patients with available electrocardiograms, 20 (71%) showed atrial arrhythmias (nine atrial premature complexes, seven atrial fibrillation, three atrial tachycardia, one ectopic atrial rhythm and one junctional rhythm). CONCLUSIONS. Massive fatty deposits in the atrial septum are associated with large deposits of fat elsewhere in the body and other parts of the heart. They are frequently associated with atrial arrhythmias and atherosclerotic coronary artery disease.

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