Modality:  Adult Echo TEE

Review the following images and see if you know what pathology is present!

TEE images of LA and RA

Color Doppler over the atrial septum demonstrating PFO.

TEE image of IAS

ANSWER: LIPOMATOUS ATRIAL SEPTAL HYPERTROPHY (LASH)

WHAT IS LIPOMATOUS HYPERTROPHY?

Although once described as a relatively rare finding, with the widespread use of echocardiography lipomatous hypertrophy is now being increasingly recognized and should be considered as part of the differential diagnosis for any atrial cardiac tumors.

• Accumulation of excessive adipose tissue in the atrial septum
• Considered a benign mass lesion
• Asymptomatic but associated with advanced age and obesity
  • Put patients at increased risk for atrial arrhythmias

WHAT DO I NEED TO KNOW REGARDING ECHO?

• ‘Dumbbell’ or ‘hourglass’ shape appearance
• Septal thickening of atrial septum excluding fossa ovalis (hint: dumbbell appearance)
• Magnitude of fat accumulation is >2.0 cm in thickness
• Cause difficultly with trans-septal puncture procedures
  • Normally cross through thin portion of septum
  • LASH can interfere with directing needle to fossa ovalis

The red circles outline the “dumbbell” shape of the LASH.

‘*’ Represent “dumbbell” appearance of LASH on TEE Image. (JASE)

CT using contrast to enhance to view of LASH. (JASE)

REFERENCES

• Alam, S. (n.d.). The Edinburgh Cardiology Imaging Website. Retrieved March 01, 2017, from http://webservice1.mvm.ed.ac.uk/imaging/demo/cases/cardiac-amyloid-echo.html
• Laura, D. M., MD, Donnino, R., MD, & Kim, E. E., MD. (2016). Lipomatous Atrial Septal Hypertrophy. JASE,29(8), 1-7. Retrieved March 2, 2017, from http://www.onlinejase.com/article/S0894-7317(16)30137-7/pdf