Background: Spindle cell lipoma is a benign adipocytic neoplasm that typically arises in subcutaneous soft tissues and is exceptionally rare in the heart.

Case summary

A 13-year-old male patient was referred for evaluation of a cardiac murmur. Transthoracic echocardiography demonstrated multiple intracardiac masses involving the aortic valve, interventricular septum, and posterior left ventricular wall, resulting in severe aortic regurgitation and moderate aortic stenosis. Cardiac magnetic resonance imaging revealed a large lobulated mass arising from the left coronary cusp of the aortic valve with extension into the left ventricular outflow tract. Given diagnostic uncertainty, surgical resection with mechanical aortic valve replacement was performed. Histopathology confirmed a spindle cell lipoma. Recovery was uncomplicated, with no residual mass on follow-up imaging.

Discussion

A systematic review identified only 2 previously reported adult cases, both involving cardiac valves. Imaging was nonspecific, and definitive diagnosis relied on histopathology.

Take-home message

Spindle cell cardiac lipoma is a rare but clinically significant cause of valvular cardiac masses; histopathological confirmation is essential, and surgical excision appears curative.

Keywords

cardiac lipoma; cardiac magnetic resonance; echocardiography; imaging.

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