CLINICAL AND MORPHOLOGIC FEATURES OF LIPOMATOUS HYPERTROPHY (MASSIVE FATTY DEPOSITS) OF THE INTERATRIAL SEPTUM

Lipomatous hypertrophy of the interatrial septum (''massive fatty depo sits in the atrial septum'') may represent an incidental autopsy findi ng or may be associated with atrial arrhythmias, obstructive symptoms, or sudden death. Antemortem diagnosis is becoming much more common. I n a literature review and in a review of our 12 cases, this condition was found to occur more frequently in obese middle-aged or elderly sub jects, who frequently demonstrated atherosclerotic coronary artery dis ease. The unencapsulated mass generally occurred anterior or superior to the fossa ovalis, and histologically was characterized by mature fa t with varying quantities of fetal fat, inflammation and fibrosis, and entrapment of myocardial fibers with cytologic atypia. Cases were inc luded that had a minimum atrial septal thickness of 1.0 cm. The septum ranged up to 7.0 cm in maximum thickness (2.6 cm average). In our cas es, no deaths were directly attributed to this disorder. It is importa nt that forensic pathologists become more generally aware of this cond ition. To further delineate the true pathological significance, the at rial septum should be routinely examined by palpation and sectioning t o determine its thickness and fat content.