International Journal of Cardiology 116 (2007) e63 – e64 www.elsevier.com/locate/ijcard
Letter to the Editor
Asympomatic intramyocardial mass: Tissue characterization by cardiovascular magnetic resonance C. Bucciarelli-Ducci a,⁎, I. Carbone b , M. Francone b , M. Osimani b , S. Sciomer a , F. Fedele a , R. Passariello b a
Department of Cardiovascular and Respiratory Sciences, Policlinico Umberto I, University of Rome “La Sapienza”, Viale del Policlinico 155, I-00161 Rome, Italy b Department of Radiological Sciences, Policlinico Umberto I, University of Rome “La Sapienza”, Rome, Italy Received 31 July 2006; accepted 4 August 2006 Available online 13 November 2006
Keywords: Intramyocardial; Mass; Tissue characterization; Cardiovascular magnetic resonance
A 44-year-old female with no past medical history was evaluated for hypertension. High blood pressure was recorded (160/100 mm Hg) and EKG showed sinus bradycardia and left anterior fascicular block. Physical examination was unremarkable. Transthoracic echocardiography showed normal systolic function and concentric left ventricular (LV) hypertrophy (14 mm); an incidental intramyocardial hyperechogenic mass (1 × 2 cm in diameter) located in the mid-inferior wall of the left ventricle was described (Fig. 1). The patient was referred for a cardiovascular magnetic resonance (CMR) for appropriate noninvasive evaluation and tissue characterization of the mass. CMR was performed with a 1.5-T scanner (Siemens Medical System). Fast-gradient-echo steady-state-free-precession (SSFP) sequence confirmed the echo findings of LV hypertrophy and normal global and regional LV function; an intramyocardial hypointense focal area in the mid-inferior wall was identified in the cine sequences. The area appeared hypointense in T1-weighted images (Fig. 2, A and B) with a significant signal reduction on fat saturation T1-weighted sequence (Fig. 2, C and D). In the inversion-recovery sequence the lesion appeared hyperintense pre-contrast with no enhancement after contrast administration (Fig. 2, E and F). Based on CMR findings, intramyocardial cardiac lipoma was diagnosed. In fact, fat can be easily characterized with CMR due to the typical T1 relaxation time and suppression ⁎ Corresponding author. Tel.: +39 06 4997 9021; fax: +39 06 4997 9060. E-mail address:
[email protected] (C. Bucciarelli-Ducci). 0167-5273/$ - see front matter © 2006 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2006.08.064
with fat saturated sequences. Left ventricular intramyocardial lipoma has been described although it is rare. A similar case of unusual fatty infiltration of the left ventricle was recently described by Heatlie et al. [1]. Its etiology is unclear although in two cases described in the literature a high alcohol intake was reported in both cases. Heatlie and colleagues [1] hypothesise that the finding might be related to the long term inflammatory and metabolic effect
Fig. 1. Transthoracic echocardiography, short axis view of the mid-cavity of the left ventricle. An hyperechogenic intramyocardial lesion was identified in the inferior wall.
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Fig. 2. Upper panel, short axis views. Bottom panel, vertical long axis views. On T1-weighted turbo spin echo images (A and B) the lesion in the inferior wall of the left ventricle is bright. The signal intensity of this area is markedly reduced on fat saturation T1-weighted turbo spin echo images (C and D). On delayed enhancement images (E and F) the hyperintensity of the area is unchanged compared with T1-weighted turbo spin echo images.
of excess alcohol. However, the patient described in our case did not drink any alcohol. A work-up to exclude life-threatening arrhythmias and myocardial ischemia was carried out. The patient has been asymptomatic and followed-up regularly. Echocardiography is the first line noninvasive imaging modality to evaluate myocardial masses. CMR can add useful diagnostic information in addition to echocardiography due to is unique capability of noninvasive tissue characterization.
Reference [1] Heatlie G, Cornelius BC, Kilkowski A, Prasad S, Sheppard MN, Mohiaddin R. Unusual fatty infiltration of the basal left ventricle. J Cardiovasc Magn Reson 2006;8:405–6.
