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INTERESTING IMAGE
Year : 2018  |  Volume : 33  |  Issue : 4  |  Page : 374-375  

Incidental finding of lipomatous hypertrophy of the interatrial septum during 18F-fluorodeoxyglucose positron emission Tomography–Computed tomography for cervical cancer


1 Department of Nuclear Medicine, Penang Adventist Hospital, Pulau Pinang, Malaysia
2 Department of Nuclear Medicine, Hospital Pulau Pinang, Malaysia

Date of Web Publication9-Oct-2018

Correspondence Address:
Alex Cheen Hoe Khoo
Department of Nuclear Medicine, Penang Adventist Hospital 465, Jalan Burma, George Town, 10350 Penang
Malaysia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnm.IJNM_89_18

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   Abstract 


Lipomatous hypertrophy of the interatrial septum is a benign but less recognized pathology of the heart caused by benign fatty infiltration of the interatrial septum which most often spares the fossa ovalis. We share images of the incidentally detected fluorodeoxyglucose (FDG) uptake in the interatrial septum during the restaging of 18F-FDG positron emission tomography/computed tomography scan of cervical cancer.

Keywords: 18F-fluorodeoxyglucose, interatrial septum, lipomatous hypertrophy, positron emission tomography–computed tomography


How to cite this article:
Hoe Khoo AC, Mohd Nasir SM. Incidental finding of lipomatous hypertrophy of the interatrial septum during 18F-fluorodeoxyglucose positron emission Tomography–Computed tomography for cervical cancer. Indian J Nucl Med 2018;33:374-5

How to cite this URL:
Hoe Khoo AC, Mohd Nasir SM. Incidental finding of lipomatous hypertrophy of the interatrial septum during 18F-fluorodeoxyglucose positron emission Tomography–Computed tomography for cervical cancer. Indian J Nucl Med [serial online] 2018 [cited 2019 Oct 22];33:374-5. Available from: http://www.ijnm.in/text.asp?2018/33/4/374/242951



The term lipomatous hypertrophy of the interatrial septum (LHIS) is actually a misnomer and is basically proliferation unencapsulated mature fat cell infiltrating the myocardial fibers of the interatrial septum. Therefore, it is neither hypertrophy of the fat cells nor a lipoma.[1] The incidence of LHIS detected on multislice computed tomography (CT) is reported to be 2.2%, whereas the incidence of LHIS detected through echocardiogram and autopsy has been reported between 1% and 8%.[2],[3] We share images of incidentally detected fluorodeoxyglucose (FDG) uptake in the interatrial septum during restaging 18F-FDG positron emission tomography (PET)-CT scan of cervical cancer.

A 70-year-old hypertensive and diabetic woman was diagnosed with differentiated squamous cell carcinoma of the cervix in 2008. She had total abdominal hysterectomy with bilateral salphingo-oophorectomy followed by chemotherapy and local radiotherapy in 2009. She was apparently well until she was noted to have a solitary apicoposterior lung nodule measuring 8 mm on surveillance CT in late 2016. 18F-FDG PET-CT scan in February 2017 was performed 60-min postinjection of 370 megabecquerel (10 mCi) of 18F-FDG [Figure 1]. Although there is no definite value, most of the studies consider 20 mm as the defining thickness.[4],[5] Thus, this case may reflect an early stage of the disease. The etiology of LHIS is unknown, but the presence of fetal brown fat amid the matured fat cells contributes to the FDG uptake frequently seen in this condition.[5] This condition occurs predominantly in the elderly, obese female and with metabolic disorders.[4] The importance of this benign and less often recognized pathology is that there is increased incidence of atrial arrhythmias and sudden cardiac death. Fortunately, this woman did not have any cardiac arrhythmias to date and is currently also being monitored by cardiologists. Recognizing LHIS is important to avoid misdiagnosis of cardiac metastases which may lead to unnecessary cardiac surgery or given suboptimal treatment.[5],[6]
Figure 1: There was increased FDG uptake seen in the interatrial septum with standardized uptake value of 3.5 (a and c). The hypodense interatrial septum measures 6 mm on the corresponding CT images (b). There was neither FDG-avid local recurrence nor evidence of metastases seen elsewhere in the scan. The left apicoposterior lung nodule was not metabolically active

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgment

The authors would like to thank the Director-General of Health Malaysia for the permission to publish this paper.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest



 
   References Top

1.
O'Connor S, Recavarren R, Nichols LC, Parwani AV. Lipomatous hypertrophy of the interatrial septum: An overview. Arch Pathol Lab Med 2006;130:397-9.  Back to cited text no. 1
    
2.
Heyer CM, Kagel T, Lemburg SP, Bauer TT, Nicolas V. Lipomatous hypertrophy of the interatrial septum: A prospective study of incidence, imaging findings, and clinical symptoms. Chest 2003;124:2068-73.  Back to cited text no. 2
    
3.
Reyes CV, Jablokow VR. Lipomatous hypertrophy of the cardiac interatrial septum: A report of 38 cases and review of the literature. Am J Clin Pathol 1979;72:785-8.  Back to cited text no. 3
    
4.
Xanthos T, Giannakopoulos N, Papadimitriou L. Lipomatous hypertrophy of the interatrial septum: A pathological and clinical approach. Int J Cardiol 2007;121:4-8.  Back to cited text no. 4
    
5.
Fan CM, Fischman AJ, Kwek BH, Abbara S, Aquino SL. Lipomatous hypertrophy of the interatrial septum: Increased uptake on FDG PET. AJR Am J Roentgenol 2005;184:339-42.  Back to cited text no. 5
    
6.
Nadra I, Dawson D, Schmitz SA, Punjabi PP, Nihoyannopoulos P. Lipomatous hypertrophy of the interatrial septum: A commonly misdiagnosed mass often leading to unnecessary cardiac surgery. Heart 2004;90:e66.  Back to cited text no. 6
    


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