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

## TL;DR

A 48-year-old woman with rectal bleeding was found to have a rare giant pericardial lipoma, diagnosed through imaging and confirmed surgically.

## Contribution

This case highlights the importance of multimodal imaging in diagnosing rare pericardial lipomas.

## Key findings

- A large pericardial lipoma was incidentally found in a patient with rectal bleeding.
- Echocardiography and CT confirmed a mediastinal fat mass encasing the heart.
- Histologic examination confirmed the diagnosis after surgical intervention.

## 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.