Dumb-bell sign in lipomatous hypertrophy of the atrial septum

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Dumb-bell sign in lipomatous hypertrophy of the atrial septum

Dumb-bell sign in lipomatous hypertrophy of the atrial septum is described on echocardiography. Thickening of the interatrial septum spares the region of fossa ovalis, creating the dumb-bell appearance on echocardiography [1]. The lipomatous deposit may be more than 1.5 cm in size. Reyes CV et al has reported 38 cases [2]. They noted that it is more likely in seventh and eighth decades of life.

Heyer CM et al picked up 28 cases from 1292 patients who underwent multi-slice computerized tomography (MSCT) of thorax [3]. The mean age of affected patients in this series was 72.2 years. MSCT also showed the dumb bell shape in all patients with sparing of the fossa ovalis region. Atrial septal thickness ranged from 20 mm to 62 mm and craniocaudal extent ranged from 51 mm to 89 mm. Advanced age, obesity and atrial arrhythmia were associations. One patient had hemodynamic obstruction.

Reference

  1. Maleszewski JJ, Bois MC, Bois JP, Young PM, Stulak JM, Klarich KW. Neoplasia and the Heart: Pathological Review of Effects With Clinical and Radiological Correlation. J Am Coll Cardiol. 2018 Jul 10;72(2):202-227. (Demonstrates echo image of “dumb-bell” sign in the interatrial septum)
  2. 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 Nov;72(5):785-8.
  3. 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 Dec;124(6):2068-73.