PMC4998283_01
Echocardiographic findings show a large mass involving the IVS (A) and the RV wall (B) lining toward the RV cavity. The subxiphoid 4-chamber view displays the mass adherent to the IVS (white arrow) and the RV wall (black arrow; C). Schematic diagram of the subxiphoid 4-chamber view (D). IVS = interventricular septum; RV = right ventricle.
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F1
2D-TTE (Philips IE33; Philips Healthcare, Eindhoven, Netherlands) demonstrated an irregular hyperechoic mass adherent to the IVS with a broad base (Figure 1A). Incidentally, another echogenic mass measuring 4.6 x 1.5 cm was observed to be adherent to the RV wall (Figure 1B); it was irregular and showed good mobility. In the subxiphoid 4-chamber view, the mass was adherent to the IVS and the RV wall (Figure 1C and D).
Contrast enhancement ultrasound findings show few contrast agent enhancements in the tumor structure (white arrow; A); real-time 3D full-volume bird's eye view findings of the mass adherent to the IVS and attached to the RV wall (B). IVS = interventricular septum; MV = bicuspid valve; RV = right ventricle.
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F2
CEUS demonstrated that there was a slight enhancement of the contrast agent inside the mass (Figure 2A). However, subsequent RT-3DE showed the involved scope of the mass was nearly attached to the right ventricular apex (Figure 2B).
An echogenic RV mass is seen on transthoracic echocardiography. The horizontal, long-axis (4-chamber view), T1-weighted, black-blood image showing a well-circumscribed, high-signal mass in the RV cavity (arrow, A). The horizontal, long-axis, T1-weighted black-blood image showing the mass adherent to IVS (arrow, B). IVS = interventricular septum; LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle.
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F3
Images revealed a homogeneous high-signal intensity within a quite irregular mass, which was adherent to the RV side of the IVS with a broad base that measured approximately 4.0 x 1.6 cm in maximal transverse diameter (Figure 3).
Surgical and pathology findings show a yellowish tumor involving the chordae of tricuspid valve (arrow, A); the tumor is suspended by sutures (arrow, B). After resection of the tumor, a pile of tissue in the water (C); stained with hematoxylin and eosin (H&E) at 100 magnification: the tumor comprised mature adipocytes with entrapped myocardial cells (D). H&E = hematoxylin and eosin.
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F4
The tumor was removed in pieces, with part of the IVS and the tricuspid valve chordae (Figure 4A and B). The gross appearance of the surgically resected tumor was a pile of yellowish pieces of smooth tissue (Figure 4C). Histological examination of the surgical specimen was used to determine the diagnosis of infiltrating lipoma of the RV (Figure 4D).