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Lipomatous Hypertrophy IAS — EECC MCQ

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ModerateCardiac ImagingLipomatous Hypertrophy IASEECC

A 60-year-old man with suspected cardiac mass on echocardiography undergoes CMR. A well-circumscribed mass in the interatrial septum shows high signal on T1 and T2 weighted images with signal dropout on fat suppression sequences. What is the diagnosis?

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Correct answer: B — Lipomatous hypertrophy of the interatrial septum — characterised by fatty infiltration that is hyperintense on T1/T2 and suppresses with fat saturation; it is a benign incidental finding that does not require intervention

Lipomatous hypertrophy of the interatrial septum (LHIS) is a benign condition characterised by excessive fat deposition in the septum, sparing the fossa ovalis (creating a 'dumbbell' shape). CMR tissue characterisation is diagnostic: (1) high signal on T1-weighted images (fat is bright on T1); (2) high signal on T2; (3) signal dropout on fat-suppressed sequences (confirming fat content). LHIS is typically an incidental finding associated with obesity and ageing. It does not require biopsy, excision, or follow-up unless it causes haemodynamic obstruction (extremely rare) or arrhythmias. CMR's ability to characterise tissue composition (fat, water, fibrosis, iron) is its key advantage over echocardiography for cardiac masses.

Reference: EACVI Cardiac Masses Guidelines; SCMR Recommendations