AUTHOR=Yu Yi , Ding Ming , Chen Jin-Lan , Wang Ting , Chen Yu-Han , Yang Xiao-Min , Chen Su-Yun , Wang Yue-Peng , Li Yi-Gang 

TITLE=Multimodality imaging in diagnosing lipomatous atrial septal hypertrophy with atrial septal defect: a case report

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 10 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1245213

DOI=10.3389/fcvm.2023.1245213

ISSN=2297-055X

ABSTRACT=Background:
Lipomatous atrial septal hypertrophy (LASH) with atrial septal defect (ASD) is a rare congenital anomaly. Although LASH is a histologically benign cardiac lesion characterized by excessive fat deposition in the interatrial septum that spares the fossa ovale, it has been associated with supraventricular arrhythmias or sick sinus syndrome. Application of multimodal imaging is crucial for accurate diagnosis, appropriate treatment of LASH with ASD and follow-up.
Case Summary:
A 68-year-old female patient presented with recurrent chest tightness and palpitation. Multimodal imagings revealed the characterizations of LASH and ASD. Two-dimensional transesophageal echocardiography (2D-TEE) showed a “dumbbell”-shaped involvement of the cephalad and caudal regions with sparing of a single secundum ASD. The septum with brightness, an uncommon condition, characterized by deposition of unencapsulated fat cells in the atrial septum. Real-time 4-dimensional transesophageal echocardiography (RT4D-TEE) reflected the lipomatous hypertrophy of the atrial septum and an oval-shaped ASD. This was later confirmed by cardiac computer tomography angiography (CCTA). With an ASD percutaneous occlusion guided by intracardiac echocardiography, the patient achieved a good clinical response. 
Conclusion: This case demonstrates a LASH combined with ASD. Multimodality imaging can provide accurate diagnosis and may guide procedure for precise occlusion.