ArticleFrontiers in radiology2026
Pericardial lipoma encasing the right coronary artery: a multimodality imaging case report.
Article in Frontiers in radiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Pericardial lipomas are rare, benign cardiac tumors. Encasement of a coronary artery by such a tumor is extremely uncommon and significantly elevates surgical risk. We report the first case in which multimodality imaging clearly demonstrates a pericardial lipoma enveloping the right coronary artery (RCA) without luminal stenosis, adding a novel anatomical observation to the literature. Case presentation: A 32-year-old woman presented with a one-year history of exertional chest tightness and dyspnea that had worsened over three days. Physical examination and laboratory tests were unremarkable except for elevated thyroid-stimulating hormone (13.26 μIU/mL). Echocardiography revealed a 7.8 cm hypoechoic mass above the aortic root with a segment of the RCA coursing within it; color Doppler showed no flow disturbance. Contrast-enhanced cardiac computed tomography (CT) and cardiac magnetic resonance (CMR) confirmed a homogeneous fat-density mass (CT attenuation -85 HU, no enhancement, complete signal suppression on STIR) consistent with a pericardial lipoma. The tumor measured 5.5 cm in maximum transverse diameter and was seen to completely encase the RCA without stenosis. A diagnosis of pericardial lipoma with RCA encasement and concomitant subclinical hypothyroidism was made. After multidisciplinary discussion, levothyroxine was initiated and a staged plan including preoperative coronary angiography followed by surgical resection with RCA protection was formulated. The patient's symptoms resolved at discharge. At one- and three-month follow-ups she remained asymptomatic, but she subsequently declined all further contact and was lost to follow-up; no adverse cardiac events were recorded during the observation period. Conclusion: Pericardial lipomas can encase a coronary artery while maintaining luminal patency due to the compliance of adipose tissue. When a pericardial mass is detected on echocardiography, the coronary course must be actively traced. Multimodality imaging with CT and cardiac magnetic resonance (CMR) is essential for delineating the tumor-artery relationship and guiding surgical strategy. Coexisting endocrine disorders should be corrected preoperatively. Although the loss of long-term follow-up limits our conclusions, the imaging findings themselves provide an important cautionary lesson.
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