A case of pulmonary edema due to epicardial lipoma with substantial pericardial effusion

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  • 急性肺水腫をきたした著明な心嚢液貯留を伴う心外膜原発脂肪腫の1例

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A 60-year-old male was transferred to our institution with sudden onset of dyspnea. Severe disturbance of consciousness, whole body cyanosis, and hypoxia were evident; therefore, he was admitted to ICU, and mechanical ventilation was instituted immediately. Chest radiographs revealed 80.0% of cardiothoracic ratio and pulmonary edema in both the lung fields. Further, transthoracic echocardiography revealed massive pericardial effusion; thus, pericardial drainage was performed. On day 3 of admission, the pericardial drain was removed. Subsequently, the patient's respiratory and circulatory condition worsened; therefore, the pericardial drain was replaced, which resolved his respiratory and circulatory condition. The patient was eventually extubated on day 11 of admission. Cardiac computed tomography and cardiac magnetic resonance imaging revealed a 3.0 cm mass on the anterior aspect of the right ventricle. On day 32 of admission, surgery was performed. Operative findings revealed a 3.0 cm mass at the right atrioventricular groove. Following resection of the mass, persistent leakage of lymph fluid was evident; therefore, a pericardial window was created. A diagnosis of cardiac lipoma was confirmed on the basis of the pathological findings. The patient's postoperative course was uneventful, and he was discharged on day 40 of admission. This case demonstrates that although cardiac lipoma is a rare benign cardiac tumor, in rare instances, it might result in respiratory failure due to substantial pericardial effusion.

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