Asympomatic intramyocardial mass: Tissue characterization by cardiovascular magnetic resonance

Abstract

A 44-year-old female with no past medical history was evaluated for hypertension. High blood pressure was recorded (160/100 mm Hg) and EKG showed sinus bradycardia and left anterior fascicular block. Physical examination was unremarkable. Transthoracic echocardiography showed normal systolic function and concentric left ventricular (LV) hypertrophy (14 mm); an incidental intramyocardial hyperechogenic mass (1×2 cm in diameter) located in the mid-inferior wall of the left ventricle was described (Fig. 1). The patient was referred for a cardiovascular magnetic resonance (CMR) for appropriate noninvasive evaluation and tissue characterization of the mass. CMR was performed with a 1.5-T scanner (Siemens Medical System). Fast-gradient-echo steady-state-free-precession (SSFP) sequence confirmed the echo findings of LV hypertrophy and normal global and regional LV function; an intramyocardial hypointense focal area in themid-inferior wall was identified in the cine sequences. The area appeared hypointense in T1-weighted images (Fig. 2, A and B) with a significant signal reduction on fat saturation T1-weighted sequence (Fig. 2, C andD). In the inversion-recovery sequence the lesion appeared hyperintense pre-contrast with no enhancement after contrast administration (Fig. 2, E and F). Based on CMR findings, intramyocardial cardiac lipoma was diagnosed. In fact, fat can be easily characterized with CMR due to the typical T1 relaxation time and suppression