Incidental Finding of Giant Pericardial Lipoma in a Patient Referred for Rectal Bleeding. Differential Diagnosis and Treatment

Our plain-English summary of Incidental Finding of Giant Pericardial Lipoma in a Patient Referred for Rectal Bleeding. Differential Diagnosis and Treatment, by S. Campana, F. Ferrentino, M. Torri, et al (Clinical Case Reports, 2025).

The study

• Authors: S. Campana, F. Ferrentino, M. Torri, C. Rostagno
• Journal: Clinical Case Reports
• Published: 2025;13(7):e70502
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Large circumferential tumors encasing the heart are exceedingly rare, and the differential diagnosis include primary pericardial sarcomas, non-Hodgkin lymphoma, pericardial primitive neuroectodermal tumor, primary pericardial mesothelioma, and exceptionally mature benign lipoma. Lipomas are rare primary heart tumors. Most are epicardial in origin, although they may arise in the myocardium. They are usually soft masses of mature fat tissue encapsulated by a thin layer of fibrous tissue. Signs and symptoms depend on the tumor's location and size, however in several case they are found incidentally at cardiac imaging. In this 48-year-old woman referred to the emergency department for severe intestinal bleeding, echocardiography showed a large circumferential hypoechogenic space, and CT confirmed a large mediastinal fat mass encasing the heart. Multimodal imaging allowed differential diagnosis confirmed by histologic examination performed at surgery.

© 2025 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd.

In plain English

This article was a case report about one patient. It did not discuss asbestos exposure. Mesothelioma came up only as one of several diseases the doctors had to rule out. A 48-year-old woman went to the emergency department because of repeated intestinal bleeding. She had no heart symptoms. A heart ultrasound found a wide space around her heart, up to 6 cm thick. A chest CT scan showed a large fatty mass, up to 17 by 11 cm across, completely surrounding the heart. The mass looked the same as fat under the skin. She declined an MRI because of claustrophobia. A PET scan showed little or no metabolic activity in the mass, which fit a non-cancerous fatty tumor. Surgeons removed the mass through the breastbone. Afterward, fluid collected around her heart, and it was treated with steroids. Tissue examination confirmed a mature intrapericardial lipoma, a benign fatty tumor inside the sac around the heart. The authors concluded that imaging helped narrow the diagnosis, but that tissue examination after surgery gave the definite answer.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report
• Who was studied: One 48-year-old woman seen at an emergency department for repeated intestinal bleeding, with no cardiac symptoms. The report does not say where she was treated; the authors are affiliated with AOU Careggi and the Università di Firenze, Italy.
• Main results:
  • Echocardiography showed a wide pericardial space around the heart with a maximal thickness of 6 cm
  • Chest CT showed a mass with attenuation identical to subcutaneous fat, completely surrounding the heart, with maximum axial diameters of 17 × 11 cm
  • The patient declined MRI because of claustrophobia
  • PET showed minimal or absent metabolic activity in the mass (SUV max 1.4, hepatic SUV 2.5), which the authors read as consistent with lipoma
  • The mass was surgically removed through median sternotomy
  • Surgery was complicated by pericardial effusion with only mild hemodynamic impact, treated conservatively with steroids
  • Histological examination confirmed mature intrapericardial lipoma
• The authors' conclusion: The authors concluded that multimodal imaging helped define the mass and suggested a benign condition, but that histologic examination after surgical resection gave the definite diagnosis

Topics

Medical terms in this study, explained in our Lexicon: Pericardial, Differential Diagnosis, Sarcoma, Pericardial Mesothelioma.

Related studies

• Pericardial mesothelioma: an incidental intraoperative diagnosis — M. Griffin, W. Farmer, et al. (1999)
• Malignant pericardial mesothelioma. Report of two cases, review of the literature and differential diagnosis — M. Papi, G. Genestreti, et al. (2005)
• Peritoneal Carcinomatosis and Its Mimics: Review of CT Findings for Differential Diagnosis — J.H. Cho, S.S. Kim (2020)
• Peritoneal washing cytology findings of disseminated myxoid leiomyosarcoma of uterus: report of a case with emphasis on possible differential diagnosis — W.K. Ng, P.C. Lui, et al. (2002)
• Metastatic proximal epithelioid sarcoma in pleural effusion: cytopathologic findings and differential diagnosis — H. Guan, F. Haque, et al. (2013)
• Diagnosis and treatment of pericardial mesothelioma by mediastinal mass resection: a case report — L. Liang, X. Zhang, et al. (2022)

Browse more research in Clinical Case Reports, or return to medical research.