Intracavitary cardiac lipoma: a benign tumour requiring a complex treatment: a case report.

Background: Primary cardiac tumours are rare, and cardiac lipomas represent only 8.4% of these cases. Cardiac lipomas consist of two pathologically distinct types: lipomas, and lipomatous hypertrophy of the interatrial septum (LHIS). Both types can be challenging to differentiate through imaging and are often reported together in the literature, complicating an accurate count of each type. Cardiac lipomas can occur in all chambers of the heart, most commonly in the atrial septum and the right atrium, often presenting incidentally or during evaluation of non-specific symptoms. Case summary: This report presents a case of a 54-year-old female, who was incidentally found to have a large cardiac tumour during a routine abdominal ultrasound. Transthoracic and transoesophageal echocardiography revealed a 65 × 58 × 55 mm tumour occupying the right atrium. Initial suspicion pointed to a myxoma; however, surgical and pathological analysis confirmed the diagnosis of cardiac lipoma. The patient underwent complex cardiac surgery, which included tumour resection, atrial wall reconstruction, PFO closure, tricuspid ring implantation and left anterior descending artery (LAD) grafting using left internal mammary artery (LIMA). The patient recovered well however due to the perioperative complete atrioventricular (AV) block required permanent pacemaker implantation. The patient remains under regular echocardiographic follow-up to monitor for potential recurrence. Discussion: This case underscores the importance of surgical intervention for benign large intracavitary tumours to prevent mechanical and haemodynamic complications and improve long-term outcome. Carefully planning of surgical treatment should take into account the complexity of the procedure and potential conduction disturbances.