CTICasesLipomatous Hypertrophy of the Interatrial Septum
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Imaging findings
Cardiac MRI demonstrates a heterogeneous signal intensity lesion within the interatrial septum, characteristically sparing the fossa ovalis. The lesion exhibits signal intensity slightly lower than subcutaneous fat on both T1 and T2-weighted imaging, with incomplete fat suppression on fat-suppressed sequences, consistent with brown fat (due to increased triglycerides and lipids). Small vessels and flow voids are noted within the lesion. Cine images show dynamic compression of the superior vena cava (SVC), which varies during the cardiac cycle.
Key takeaways
Lipomatous hypertrophy of the interatrial septum is a benign accumulation of fat (often brown fat) within the interatrial septum, typically sparing the fossa ovalis. MRI is excellent for characterization, demonstrating fat signal with unique features (slightly lower signal than subcutaneous fat due to brown fat components) and potential dynamic mass effect on adjacent structures like the SVC. It is important to differentiate this benign entity from cardiac tumors.
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