Myocardial Fatty Infiltration

Differential diagnosis for fatty infiltration of the myocardium:

• Prior ischemic damage: Usually thin and curvilinear subendocardial lesions.
• Normal heart: Right ventricular fat increases with age.
• Tuberous sclerosis complex (TSC): There is a high prevalence of well-circumscribed, mainly ovoid, myocardial fatty foci is TSC. The majority of fatty foci are in the interventricular septum and the left ventricular wall.
• Arrhythmogenic right ventricular dysplasia: Usually diffuse fat infiltration of the right ventricle.
• Primary cardiac hemangioma: May contain fat. Isointense to myocardium on T1-weighted images, hyperintense on T2-weighted images, and intense early enhancement that can be heterogeneous. There is filling on delayed phases of enhancement.
• Intramyocardial lipoma: Small lesions with irregular contour and capsule.
• Liposarcoma: Typically demonstrate mass effect and invasion.

References

• Adriaensen ME, Schaefer-Prokop CM, Duyndam DA, Zonnenberg BA, Prokop M. Fatty foci in the myocardium in patients with tuberous sclerosis complex: common finding at CT. Radiology. 2009 Nov;253(2):359-63.
• .Diagnostic features of cardiac hemangioma on cardiovascular magnetic resonance, a case report. Int J Cardiovasc Imaging. 2006 Oct;22(5):699-702.
• Pigato JB, Subramanian VA, McCaba JC. Cardiac hemangioma. A case report and discussion. Tex Heart Inst J. 1998; 25(1): 83–85.