Isolated lipoleiomyomas in the right ventricle

A 54-year-old female was incidentally found to have a right ventricular mass. She had a previous history of diabetes and hypertension for 5 years. A retroperitoneal leiomyoma was resected 13 years ago. Laboratory tests and physical examination were unremarkable. Colour Doppler examination of the inferior vena cava was unremarkable. Two-dimensional transoesophageal echocardiography (2D-TEE) showed beaded, seaweed-like, and strip-shaped abnormal echogenicity in the right ventricle, which fluctuated with the cardiac cycle in the mid-oesophageal right ventricular outflow tract view (Panel A). The mass was attached to the tricuspid valve septum and subvalvular chordae tendineae and extended to the right ventricular outflow tract during systole. 2D-TEE clearly displayed lesions in the transgastric right ventricular inflow–outflow tract view (Panel B, Video A). The patient underwent resection of the right ventricular mass under extracorporeal circulation. Intraoperative exploration showed multiple lesions on the septal tricuspid valve leaflet and chordae tendineae. The lesions originating from the leaflet were seaweed-like (Panel C), and those from the chordae tendineae were bead-like, banded, and ∼4 cm long (Panel D). The lesions and tendinous cord from which the tumour originated were removed, and an artificial tendinous cord was implanted. Post-operative pathological examination confirmed a lipoleiomyoma (Panel E). The patient recovered uneventfully and was discharged 5 days later. Isolated cardiac lipoleiomyomas are extremely rare, with involvement of the tricuspid valve even rarer. Patients should undergo surgical excision due to the risks of embolism, rupture, and sudden death. The unique morphology on imaging is helpful for pre-operative diagnosis.

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Funding: None declared.

Data availability: No data were generated or analysed for or in support of this paper.

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