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Magnetic resonance imaging diagnosing a left ventricular lipoma in a patient with T wave changes on ECG
  1. A Azarine,
  2. S Castela,
  3. E Mousseaux

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A 75 year old woman, with no cardiovascular history, was incidentally found with negative T waves in inferior leads. Echocardiography suspected a non-obstructive hypertrophic cardiomyopathy localised at the inferior wall (measured at 32 mm).

Cardiac magnetic resonance imaging (MRI) was performed to confirm the diagnosis and to detect associated ischaemic myocardial disease (1.5T, Signa, General Electric Medical Systems, Milwaukee, USA). Black blood T1 weighted fast spin echo images revealed a well delineated and non-infiltrative high signal intramyocardial ovoid mass of the left ventricle (LV) inferior wall (panel A). Fat suppressed T1 weighted images showed the mass in signal void (panel B). The first pass perfusion with gadolinium and the delayed enhancement sequence showed no perfusion of the cardiac mass. No ischaemic involvement of the myocardium was demonstrated by MRI. These MRI findings established the diagnosis of cardiac lipoma of the inferior LV wall inducing T wave changes in inferior leads.

Cardiac lipoma is the second most frequent benign tumour of the heart. One quarter of lipomas arise within the myocardium.

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T1 weighted double inversion recovery fast spin echo image of the heart, short axis view. Image reveals a well delineated, non-infiltrative, high signal ovoid mass localised within the myocardium of the left ventricular (LV) inferior wall. The LV myocardium is seen in lower signal without hypertrophy.

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Fat suppressed image of the same slice shows the ovoid mass of the LV inferior wall in signal void, suggesting the diagnosis of cardiac lipoma.