A diagnostic conundrum: Role of multimodality imaging in evaluating a rare intracardiac mass.

Abstract

A 26-year-old male with history of generalized anxiety disorder presented to the emergency department with palpitations. He was diagnosed with supraventricular tachycardia; administration of adenosine restored normal sinus rhythm. Subsequent cardiovascular examinations and serial electrocardiograms (ECG) were unremarkable. Transthoracic echocardiogram identified a large, mid-septal mass that appeared to extend into both ventricular cavities (Panels A and B). The mass demonstrated perflutren uptake, suggesting hypervascularity (Panel B). No other significant abnormalities were identified. Cardiac magnetic resonance imaging demonstrated a hyperintense 2.5 cm × 1.8 cm mass (Supplementary data online, Video S1) within the interventricular septum on T2-weighted (T2W) images (Panel C), with hypointensity on T2W fat suppression imaging (Panel D). These findings were consistent with fat content and suggested intracardiac lipoma. Gated computed tomography revealed negative Hounsfield units (−71.33) and importantly, no features suggesting malignancy (Panel E). The collective...