Pericardial lipomas are slowly growing benign tumours of the pericardium that are asymptomatic unless large in size, where they can cause pressure symptoms.
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Clinical presentation
Pericardial lipomas are usually asymptomatic.
Occasionally non-specific symptoms are present including:
chest pain
breathlessness
dizziness
Symptoms occur due to extrinsic compression of the heart, usually of the right atrium or ventricle, or compression of coronary artery or dysfunction of one of the heart valves 2.
Pathology
True lipomas of the heart are encapsulated or enveloped by cardiac muscle. They may occur in any part of the heart including the pericardium 3.
Radiographic features
Echocardiography
The lipoma tends to be an echogenic structure adjacent to or inside the pericardium.
CT
Seen as a fatty attenuating tumour that displays <0 HU density. No enhancement post-contrast administration. The lesion may not be well-circumscribed like other lipomas.
MRI
Exhibits bright signal on T1 and T2 with no contrast enhancement. Fat suppression techniques e.g. STIR, SPAIR, and fat saturation, confirm the fatty contents.
Differential diagnosis
Imaging differential considerations include
pericardial lipoblastoma: can have a similar appearance but tends to occur in children <3 years of age
pericardial liposarcomas: extremely rare
As a broader differential consider
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