Abstract
BACKGROUND: Cardiac lipomas are rare benign tumors with symptoms that vary with location, although most are asymptomatic. CASE SUMMARY: A 31-year-old man, under follow-up for 10 years for an asymptomatic cardiac lipoma, was referred after an out-of-hospital resuscitated cardiac arrest while boxing. Echocardiography, computed tomography, and cardiac magnetic resonance revealed a large interventricular septal mass extending into both ventricles, with fat tissue characteristics, no (18)F-fluorodeoxyglucose avidity on positron emission tomography, and with minimal growth over the past 10 years. Coronary angiography was normal. Holter monitoring showed 5 runs of nonsustained ventricular tachycardia. DISCUSSION: Resection of such a large tumor poses major surgical challenges. A decision was made to proceed with extravascular implantable cardioverter-defibrillator placement for secondary prevention, with surgical resection or heart transplantation to be considered in the future in case of recurrent malignant ventricular arrhythmias. TAKE-HOME MESSAGE: This case illustrates the challenges of managing a large cardiac lipoma and underscores the importance of careful long-term follow-up.