Giant Lipoma in Superior Vena Cava: A Case Report and Literature Review

Giant Lipoma in Superior Vena Cava: A Case Report and Literature Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Giant Lipoma in Superior Vena Cava: A Case Report and Literature Review Tri Wisesa Soetisna, Lisca Namretta, Bagus Ronidipta, Elen Elen, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-542232/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Intravascular lipomas were a rare occurrence, especially in major vessels. This tumor is composed of adipocytes in a fibrous capsule that had a slow growth rate and usually shows no symptoms. There were only eight reports in the literature regarding intravascular lipoma located in the superior vena cava. Case presentation: A 54-year-old man had episodes of supraventricular tachycardia and atrial flutter for over a year. Radiological findings preoperative showed a giant mass that arose from superior vena cava to right atrium and biopsy catheter showed that there were no signs of malignancy. The patient then underwent surgery through a median sternotomy and the mass was extirpated on the highest part of the stalk that could be reached. The patient was stable and remains to show no symptoms or evidence of residual mass or stalk in 2 years follow-up. Conclusion: The surgical approach in excising lipoma in SVC should be considered wisely with the support of adequate preoperative diagnostic. Extensive manipulation that could increase surgical technique difficulty or postoperative morbidity and mortality is not necessary since lipoma is a very slow-growing tumor. Cardiothoracic Surgery Cardiac & Cardiovascular Systems Lipoma Superior Vena Cava Intravascular Tumor Figures Figure 1 Figure 2 Figure 3 Background Primary benign tumors that originate from the intravascular wall are considered a rare occurrence. Among all of them, lipomas were found to be extremely rare, especially the ones that occur in superior vena cava (SVC).1 Currently there were only 30 pieces of literature found on PubMed by using search terms “intravascular lipoma”, “superior vena cava lipoma” and “intravenous lipoma”. There were only eight cases found regarding intravascular lipoma located in the SVC. 2 Intravascular lipomas were composed of adipocytes in a fibrous capsule that had a slow growth rate. It usually shows no symptoms that it commonly diagnosed after an incidental finding. 3 Even though only large-sized of this tumor could cause obstructive symptoms, many had believed that it better be surgically removed due to its probability of causing turbulent blood flow and subsequently thrombotic complication in the venous portal system. 4 Case Presentation A 54-year-old man had episodes of supraventricular tachycardia and atrial flutter for over a year. The patient was an ex-smoker with a history of hypertension, dislipidemia, and a family history of sudden cardiac death. The physical examination results were unremarkable. Transthoracic echocardiography (TTE) examination shows a large mass at right atrium (RA) with the size 4,7 x 3,6 cm, occupy more than half of RA chambers. The left ventricle is normal in size and function, with an ejection fraction of 73%. Other findings in TTE were normal. A computed tomography scan (CT) showed an elongated lesion with low density that arose from SVC to RA (Fig. 1 a). Magnetic resonance imaging (MRI) examination confirmed a big capsulated mass that arose from SVC to RA with the size of 12x4x4cm (Fig. 1 b). The mass was confirmed as a fat-rich content and diagnosed as lipoma. Given the size and patient’s age, malignancy could not be excluded. Therefore the patient underwent biopsy by catheterization and the results showed that there were no signs of malignancy. The patient was prepared for extirpation and underwent catheterization. It was found that the left main artery had 20–30% stenosis on the distal, left anterior descending artery had 40–50% stenosis on the middle, left circumflex artery had 60–70% stenosis on the distal, and right coronary artery had 50% discrete stenosis on the proximal. The patient was diagnosed with a moderate 3-vessel disease of the coronary artery, and it was decided to be treated conservatively. The median sternotomy approach was chosen and we found that SVC was 2 times bigger than the aorta. Under guiding TEE the mass found to be occupied the SVC, then we decided to canulate the internal jugular vein and IVC. Under a total bypass with a cardiopulmonary bypass machine, RA was opened and we found a yellowish mass inside the RA that originate from SVC. The mass has a stalk that origin from the cranial of SVC. The mass was yellowish with the size of 15x5x4 cm, had a lobulated surface, mobile, and had rubbery consistency (Fig. 2 ). We pulled the mass and extirpated it on the highest part of the stalk that could be reached. RA was closed and cardiopulmonary bypass was quickly discontinued without any problem, and the surgery was done smoothly. The patient was stable with normal sinus rhythm on ECG post-surgery and was discharged four days after. Pathology examination shows mature white adipose cells with no-centrally located nuclei dominated this mass, thin fibrous septa in some parts, and a few blood vessels. These histologic findings confirmed the mass as lipoma. The patient underwent cardiac rehabilitation program after being discharged and remains to show no symptoms in 2 years follow-up. There is also no evidence of residual mass or stalk on the SVC on Cardiac MRI with four chamber and right ventricle two chamber stack 10 slices, slice thickness 6 mm that was performed extended to the cervical region on 2 years follow-up (Fig. 3 ). Discussion And Conclusions Lipomas are benign tumors that rarely occur intraluminal in major vessels, which most prevalent in people between 40–60 years. It usually shows no symptoms, but when present it usually shows obstructive symptoms of cardiovascular like congestiveness and edema. 5 – 6 We only found eight cases of SVC lipoma from a literature search in PubMed (Table 1 .). Four cases described that patients showed obstructive symptoms. In our case, the patient shows symptoms of periodical arrhythmia which has never been described in other cases even though the one that extended to the right atrium like ours. We assumed that the symptom was due to its position in RA and its gigantic size, therefore we decided not to do any invasive intervention to it. It was confirmed so that the arrhythmia was disappeared after the resection. Table 1 Author (Year) Gender/Age Clinical Presentation Prediagnostic modalities Tumor Size Surgical Approach Vinnicombe S (1994) 10 F, 42 y.o Fatigue, edema face and right hand CT scan : rounded mass of fat compressing proximal right brachiocephalic vein and SVC Venogram : large lobulated filling defect up to 3.5cm diameter in SVC 10x5x5cm not well described Thorogood SV (1996) 11 M, 73 y.o Asymptomatic CT scan : mass of fat density in SVC and the right braciocephalic vein not specified no surgical intervention Mordant P. (2010) 12 F, 55 y.o Asymtompatic CT scan : intraluminal nonenhancing tumor occluding the distal right subclavian vein, the right brachiocephalic vein, and the SVC up to the right atrium Venogram : total occlusion of the right subclavian and brachiocephalic veins and of the SVC to the level of the azygos vein MRI : fatty intravascular lesion 9x6cm median sternotomy with right transclavicular cervicotomy. Transverse venotomy in SVC. En bloc resection, end-to-end anastomosis left innominate vein - SVC Bravi MC (2011) 4 M, 63 y.o Abdominal, right shoulder, and lumbar pain CT scan : superior vena caval (SVC) filling defect with a subtotal occlusion that extended into the right atrium. MRI: uniform signal drop on fat-suppressed sequences not specified not well described Tanyeli O (2015) 1 M, 48 y.o Right arm edema and paresthesia CT scan and MRI : fat density within SVC 5x2cm mini J sternotomy, venotomy Concatto NH (2015) 13 M, 58 y.o Asymptomatic CT scan : a hypodense elongated lesion with fat density within the superior vena cava MRI : confirmed the fatty nature of the lesion 11 x 3 cm not well described Wahab A (2017) 14 F, 70 y.o Asymptomatic TEE : 2.6x1.6x1.6 cm partially obstructing round, echogenic mass at SVC and RA juction 2–3 cm No surgical intervention Sundaram N (2020) 2 M, 58 y.o Asymptomatic CT scan : intraluminal 5 cm mass in the right innominate vein extending into SVC Venous duplex : large pedunculated 5 cm hyperechoic mass at the junction of the right internal jugular and subclavian veins 5 cm median sternotomy with right cervical extension, venotomy in SVC, counter incision in right mid-jugular vein Soetisna TW. Et al (2021) M, 54 y.o Episodes of SVT and atrial flutter CT scan : elongated lesion with low density from SVC to RA MRI : big capsulated mass from SVC to RA (fat-rich content) 15x5x4cm conventional median sternotomy None of those eight cases underwent biopsy before the intervention. There were only a few articles about intravascular lipoma and there was no literature that shows the incidents of intravascular lipoma or liposarcoma. Despite it, there were data about the incidence of lipoma and liposarcoma originated from the heart that shows the rarity of the case (lipoma 0.07%-8.4%; liposarcoma 0.19%-0.5%). 7 Nevertheless the rarity of malignancy incidence in the cardiovascular tumor, we still cannot exclude the possibility of malignancy, in this case, due to its size (the biggest lipoma ever been reported in SVC) and the age of the patient. Studies have shown cardiac MRI to be the gold standard diagnostic imaging modality for cardiac lipoma, but it has limited sensitivity that could only distinguish 69% of cases in the setting of well-differentiated liposarcoma. 8 Given that malignant tumor originated from cardiovascular required different consideration in treatment options, therefore we still encourage to do the biopsy before intervention to better weigh the risks and benefit of the surgical treatment. In our case, the cardiac CT and cardiac MRI didn’t specify the origin of the lipoma’s stalk; it was fully described by Elen, et al. 9 Given the uncertainty of the tumor origin, we decided to not performed any extensive manipulation due to its probability of increasing surgical technique difficulty and postoperative morbidity or mortality. Two years after, the patient remains to shows no symptoms, and Cardiac MRI also shows no evidence of recurrence of the tumor or the stalk. This evidence certifies that it is not necessary to do any extensive manipulation or other surgical approaches to reach the origin of the stalk since lipoma is a very slow-growing tumor. Nevertheless, we still encourage to do throughout diagnostic approach before the procedure to define the whole mass’ precise location. Extension of cardiac MRI to the cervical region or venography should be considered in any similar cases. The surgical approach in excising lipoma in SVC should be considered wisely with the support of adequate preoperative diagnostic. Extensive manipulation that could increase surgical technique difficulty or postoperative morbidity and mortality is not necessary since lipoma is a very slow-growing tumor. Abbreviations SVC Superior vena cava; TTE:Transthoracic echocardiography; RA:Right Atrium; CT:Computed tomography; MRI:Magnetic resonance imaging; TEE:Transesophageal echocardiography; IVC:Inferior vena cava; ECG:Electrocardiogram Declarations Ethics approval and constent to participate Not applicable. Consent for publication Informed consent was obtained from the patient. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interest The authors declare that they have no competing interests. Funding There was no funding for this case report. Author’s contributions Tri Wisesa Soetisna: [email protected] : conceptualized, wrote the paper and reviewed the literature. Lisca Namretta: [email protected] : wrote the manuscript and edited the paper. Bagus Ronidipta: [email protected] : reviewed the literature. Elen Elen: [email protected] : validated the data and reviewed the paper. Sunu Budhi Raharjo: [email protected] : reviewed and edited the paper. Amin Tjubandi: [email protected] : supervised, reviewed the literature and edited the paper. Acknowledgements Not applicable. References Tanyeli O, Dereli Y, Gormus N, Odev K. Primary Intravascular Lipoma of the Superior Vena Cava. Balkan Med J . 2015;32(3):333-334. doi:10.5152/balkanmedj.2015.15808. Sundaram N, Kulkarni R, Sultan I, Singh M. Surgical Resection of a Symptomatic Superior Vena Cava Lipoma: A Case Report and Literature Review. Ann Vasc Surg . 2021;71:535.e11-535.e15. doi:10.1016/j.avsg.2020.09.052. Doyle Z, Wolford B, Morshedi M, Santillan C. Intravascular lipoma of the renal vein. BJR|case reports . 2015;1(2):20150072. doi:10.1259/bjrcr.20150072. Bravi M, Salvadei S, Scarponi P, Loforte A, Musumeci F, Gasbarrone L. Intravascular lipoma of the superior vena cava. Intern Emerg Med . 2011;7(1):79-81. doi:10.1007/s11739-011-0584-9. D’Souza J, Shah R, Abbass A, Burt J, Goud A, Dahagam C. Invasive Cardiac Lipoma: a case report and review of literature. BMC Cardiovasc Disord . 2017;17(1). doi:10.1186/s12872-016-0465-2. Ismail I, Al-Khafaji K, Mutyala M, Aggarwal S, Cotter W, Hakim H, Khosla S, Aora r. Cardiac Lipoma. J Community Hosp Intern Med Perspect. 2015;5(5):28449. Amano J, Nakayama J, Yoshimura Y, Ikeda U. Clinical classification of cardiovascular tumors and tumor-like lesions, and its incidences [published correction appears in Gen Thorac Cardiovasc Surg. 2013 Aug;61(8):448]. Gen Thorac Cardiovasc Surg . 2013;61(8):435-447. doi:10.1007/s11748-013-0214-8. O'Donnell PW, Griffin AM, Eward WC, et al. Can Experienced Observers Differentiate between Lipoma and Well-Differentiated Liposarcoma Using Only MRI?. Sarcoma . 2013;2013:982784. doi:10.1155/2013/982784. Elen E, D’Angelo T, Tjubandi A, Raharjo S. A rare case of superior vena cava lipoma: its presentation from non-invasive examination. European Heart Journal - Cardiovascular Imaging. 2019;20(10):1183-1183. Vinnicombe S, Wilson A, Morgan R, Saunders K. Intravascular Lipoma of the Superior Vena Cava. Journal of Computer Assisted Tomography. 1994;18(5):824-827. Thorogood S, Maskell G. Intravascular lipoma of the superior vena cava—CT and MRI appearances. The British Journal of Radiology. 1996;69(826):963-964. Mordant P, Mercier O, Fadel E, Muniappan A, Fabre D, Chataigner O et al. Surgical resection of an intravascular superior vena cava primary lipoma. The Journal of Thoracic and Cardiovascular Surgery. 2010;140(6):1437-1438. Concatto N, Camargo S, Camargo J, Hochhegger B, Irion K, Marchiori E. Superior Vena Cava Lipoma in an Asymptomatic Man. Lung. 2015;193(5):847-849. Wahab A, Chaudhary S, Munir A, Smith S. Lipoma of superior vena cava: a rare occurrence. BMJ Case Reports. 2017;:bcr-2017-220641. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-542232","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":28716640,"identity":"76266b54-d316-461b-81da-7846f9824def","order_by":0,"name":"Tri Wisesa Soetisna","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0klEQVRIiWNgGAWjYFACxgYgYcPDxsx8AMImBHhAyg4wpMnxs7clEKsFCA4wHDaW7DljQJwWe+nDjZ8//GFO3HAj55vEzx02cgzsh49uwGsLX2KzxME2NqCW3G2SvWfSjBl40tJu4NXCw9jGcLCBB6xFgrftcGKDBI8ZYS0H/kiAHPZM8i/xWtgMQN5nkybOljOMzRJn2xJAgWxsLduWZsxGyC/sPewPP1T8+Q+Kyoc337bZAPUePoZXCzJgkQCRbMQqBwHmD6SoHgWjYBSMgpEDAME9S0bNaYzkAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0002-7428-3600","institution":"Pusat Jantung Nasional Harapan Kita: Pusat Jantung Nasional","correspondingAuthor":true,"prefix":"","firstName":"Tri","middleName":"Wisesa","lastName":"Soetisna","suffix":""},{"id":28716641,"identity":"1a87d16d-8e88-470f-848b-4c8a6bf1b60e","order_by":1,"name":"Lisca Namretta","email":"","orcid":"","institution":"Pusat Jantung Nasional Harapan Kita: Pusat Jantung Nasional","correspondingAuthor":false,"prefix":"","firstName":"Lisca","middleName":"","lastName":"Namretta","suffix":""},{"id":28716642,"identity":"65fdd9ab-5f61-48e0-b02f-b1dbaf4cd08d","order_by":2,"name":"Bagus Ronidipta","email":"","orcid":"","institution":"Pusat Jantung Nasional Harapan Kita: Pusat Jantung Nasional","correspondingAuthor":false,"prefix":"","firstName":"Bagus","middleName":"","lastName":"Ronidipta","suffix":""},{"id":28716643,"identity":"e5ada92a-a766-45d2-9e23-cc85da816808","order_by":3,"name":"Elen Elen","email":"","orcid":"","institution":"Pusat Jantung Nasional Harapan Kita: Pusat Jantung Nasional","correspondingAuthor":false,"prefix":"","firstName":"Elen","middleName":"","lastName":"Elen","suffix":""},{"id":28716644,"identity":"14cc3c01-72d5-4c81-879e-5219d945d7f6","order_by":4,"name":"Sunu Budhi Raharjo","email":"","orcid":"","institution":"Pusat Jantung Nasional Harapan Kita: Pusat Jantung Nasional","correspondingAuthor":false,"prefix":"","firstName":"Sunu","middleName":"Budhi","lastName":"Raharjo","suffix":""},{"id":28716645,"identity":"11e55e5f-a0c3-48b0-8920-8465e1383f8f","order_by":5,"name":"Amin Tjubandi","email":"","orcid":"","institution":"Pusat Jantung Nasional Harapan Kita: Pusat Jantung Nasional","correspondingAuthor":false,"prefix":"","firstName":"Amin","middleName":"","lastName":"Tjubandi","suffix":""}],"badges":[],"createdAt":"2021-05-20 09:01:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-542232/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-542232/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":9728351,"identity":"3f536d17-0f53-45a3-86ca-043fbac33e05","added_by":"auto","created_at":"2021-05-28 19:34:50","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":50468,"visible":true,"origin":"","legend":"Preoperative radiology. (a) CT scan coronal plane; (b) Cardiac MRI T1-weighted image axial plane.","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-542232/v1/4f3a74c9a72f230f69ae6cd9.jpg"},{"id":9728352,"identity":"32ccf6dd-ba72-4abd-b2b5-46adf3355b97","added_by":"auto","created_at":"2021-05-28 19:34:50","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":48181,"visible":true,"origin":"","legend":"Giant lipoma after surgically resected","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-542232/v1/c4ff6f4ab8060e9001240563.jpg"},{"id":9727947,"identity":"dbcd9665-b6a7-4a3e-bbc7-377aa576f183","added_by":"auto","created_at":"2021-05-28 19:31:50","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":35716,"visible":true,"origin":"","legend":"year post operatif cardiac MRI (cMRI). (a) Cine cMRI coronal plane; (b) Cine cMRI axial plane.","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-542232/v1/5dc4a9b4fa66433ed6c232fc.jpg"},{"id":17349564,"identity":"6e83fb0a-6108-4cd4-9f81-74f23d421f4f","added_by":"auto","created_at":"2022-01-15 19:30:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":523543,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-542232/v1/ed3d2708-3c47-4dbe-ab6b-5e258f1e71d9.pdf"}],"financialInterests":"","formattedTitle":"\u003cp\u003eGiant Lipoma in Superior Vena Cava: A Case Report and Literature Review\u003c/p\u003e","fulltext":[{"header":"Background","content":" \u003cp\u003ePrimary benign tumors that originate from the intravascular wall are considered a rare occurrence. Among all of them, lipomas were found to be extremely rare, especially the ones that occur in superior vena cava (SVC).1 Currently there were only 30 pieces of literature found on PubMed by using search terms \u0026ldquo;intravascular lipoma\u0026rdquo;, \u0026ldquo;superior vena cava lipoma\u0026rdquo; and \u0026ldquo;intravenous lipoma\u0026rdquo;. There were only eight cases found regarding intravascular lipoma located in the SVC.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIntravascular lipomas were composed of adipocytes in a fibrous capsule that had a slow growth rate. It usually shows no symptoms that it commonly diagnosed after an incidental finding.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Even though only large-sized of this tumor could cause obstructive symptoms, many had believed that it better be surgically removed due to its probability of causing turbulent blood flow and subsequently thrombotic complication in the venous portal system.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e "},{"header":"Case Presentation","content":" \u003cp\u003eA 54-year-old man had episodes of supraventricular tachycardia and atrial flutter for over a year. The patient was an ex-smoker with a history of hypertension, dislipidemia, and a family history of sudden cardiac death. The physical examination results were unremarkable. Transthoracic echocardiography (TTE) examination shows a large mass at right atrium (RA) with the size 4,7 x 3,6 cm, occupy more than half of RA chambers. The left ventricle is normal in size and function, with an ejection fraction of 73%. Other findings in TTE were normal. A computed tomography scan (CT) showed an elongated lesion with low density that arose from SVC to RA (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003ea). Magnetic resonance imaging (MRI) examination confirmed a big capsulated mass that arose from SVC to RA with the size of 12x4x4cm (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eb). The mass was confirmed as a fat-rich content and diagnosed as lipoma. Given the size and patient\u0026rsquo;s age, malignancy could not be excluded. Therefore the patient underwent biopsy by catheterization and the results showed that there were no signs of malignancy. The patient was prepared for extirpation and underwent catheterization. It was found that the left main artery had 20\u0026ndash;30% stenosis on the distal, left anterior descending artery had 40\u0026ndash;50% stenosis on the middle, left circumflex artery had 60\u0026ndash;70% stenosis on the distal, and right coronary artery had 50% discrete stenosis on the proximal. The patient was diagnosed with a moderate 3-vessel disease of the coronary artery, and it was decided to be treated conservatively.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe median sternotomy approach was chosen and we found that SVC was 2 times bigger than the aorta. Under guiding TEE the mass found to be occupied the SVC, then we decided to canulate the internal jugular vein and IVC. Under a total bypass with a cardiopulmonary bypass machine, RA was opened and we found a yellowish mass inside the RA that originate from SVC. The mass has a stalk that origin from the cranial of SVC. The mass was yellowish with the size of 15x5x4 cm, had a lobulated surface, mobile, and had rubbery consistency (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). We pulled the mass and extirpated it on the highest part of the stalk that could be reached. RA was closed and cardiopulmonary bypass was quickly discontinued without any problem, and the surgery was done smoothly. The patient was stable with normal sinus rhythm on ECG post-surgery and was discharged four days after.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003ePathology examination shows mature white adipose cells with no-centrally located nuclei dominated this mass, thin fibrous septa in some parts, and a few blood vessels. These histologic findings confirmed the mass as lipoma. The patient underwent cardiac rehabilitation program after being discharged and remains to show no symptoms in 2 years follow-up. There is also no evidence of residual mass or stalk on the SVC on Cardiac MRI with four chamber and right ventricle two chamber stack 10 slices, slice thickness 6 mm that was performed extended to the cervical region on 2 years follow-up (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e "},{"header":"Discussion And Conclusions","content":" \u003cp\u003eLipomas are benign tumors that rarely occur intraluminal in major vessels, which most prevalent in people between 40\u0026ndash;60 years. It usually shows no symptoms, but when present it usually shows obstructive symptoms of cardiovascular like congestiveness and edema.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e We only found eight cases of SVC lipoma from a literature search in PubMed (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.). Four cases described that patients showed obstructive symptoms. In our case, the patient shows symptoms of periodical arrhythmia which has never been described in other cases even though the one that extended to the right atrium like ours. We assumed that the symptom was due to its position in RA and its gigantic size, therefore we decided not to do any invasive intervention to it. It was confirmed so that the arrhythmia was disappeared after the resection.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e\u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAuthor (Year)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGender/Age\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eClinical Presentation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePrediagnostic modalities\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTumor Size\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSurgical Approach\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVinnicombe S (1994)\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF, 42 y.o\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFatigue, edema face and right hand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eCT scan\u003c/b\u003e: rounded mass of fat compressing proximal right brachiocephalic vein and SVC\u003c/p\u003e \u003cp\u003e\u003cb\u003eVenogram\u003c/b\u003e: large lobulated filling defect up to 3.5cm diameter in SVC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10x5x5cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003enot well described\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThorogood SV (1996)\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM, 73 y.o\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAsymptomatic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eCT scan\u003c/b\u003e: mass of fat density in SVC and the right braciocephalic vein\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003enot specified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eno surgical intervention\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMordant P. (2010)\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF, 55 y.o\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAsymtompatic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eCT scan\u003c/b\u003e: intraluminal nonenhancing tumor occluding the distal right subclavian vein, the right brachiocephalic vein, and the SVC up to the right atrium\u003c/p\u003e \u003cp\u003e\u003cb\u003eVenogram\u003c/b\u003e: total occlusion of the right subclavian and brachiocephalic veins and of the SVC to the level of the azygos vein\u003c/p\u003e \u003cp\u003e\u003cb\u003eMRI\u003c/b\u003e: fatty intravascular lesion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9x6cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003emedian sternotomy with right transclavicular cervicotomy. Transverse venotomy in SVC. En bloc resection, end-to-end anastomosis left innominate vein - SVC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBravi MC (2011)\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM, 63 y.o\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAbdominal, right shoulder, and lumbar pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eCT scan\u003c/b\u003e: superior vena caval (SVC) filling defect with a subtotal occlusion that extended into the right atrium. MRI: uniform signal drop on fat-suppressed\u003c/p\u003e \u003cp\u003esequences\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003enot specified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003enot well described\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTanyeli O (2015)\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM, 48 y.o\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRight arm edema and paresthesia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eCT scan and MRI\u003c/b\u003e: fat density within SVC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5x2cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003emini J sternotomy, venotomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConcatto NH (2015)\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM, 58 y.o\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAsymptomatic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eCT scan\u003c/b\u003e: a hypodense elongated\u003c/p\u003e \u003cp\u003elesion with fat density within the superior vena cava\u003c/p\u003e \u003cp\u003e\u003cb\u003eMRI\u003c/b\u003e: confirmed the fatty nature of the lesion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11 x 3 cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003enot well described\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWahab A (2017)\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF, 70 y.o\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAsymptomatic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eTEE\u003c/b\u003e: 2.6x1.6x1.6 cm partially obstructing round, echogenic mass at SVC and RA juction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u0026ndash;3 cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo surgical intervention\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSundaram N (2020)\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM, 58 y.o\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAsymptomatic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eCT scan\u003c/b\u003e: intraluminal 5 cm mass in the right innominate vein extending into SVC\u003c/p\u003e \u003cp\u003e\u003cb\u003eVenous duplex\u003c/b\u003e: large pedunculated 5 cm hyperechoic mass at the junction of the right internal jugular and subclavian veins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003emedian sternotomy with right cervical extension, venotomy in SVC, counter incision in right mid-jugular vein\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSoetisna TW. Et al (2021)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM, 54 y.o\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEpisodes of SVT and atrial flutter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eCT scan\u003c/b\u003e: elongated lesion with low density from SVC to RA\u003c/p\u003e \u003cp\u003e\u003cb\u003eMRI\u003c/b\u003e: big capsulated mass from SVC to RA (fat-rich content)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15x5x4cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003econventional median sternotomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eNone of those eight cases underwent biopsy before the intervention. There were only a few articles about intravascular lipoma and there was no literature that shows the incidents of intravascular lipoma or liposarcoma. Despite it, there were data about the incidence of lipoma and liposarcoma originated from the heart that shows the rarity of the case (lipoma 0.07%-8.4%; liposarcoma 0.19%-0.5%).\u003csup\u003e7\u003c/sup\u003e Nevertheless the rarity of malignancy incidence in the cardiovascular tumor, we still cannot exclude the possibility of malignancy, in this case, due to its size (the biggest lipoma ever been reported in SVC) and the age of the patient. Studies have shown cardiac MRI to be the gold standard diagnostic imaging modality for cardiac lipoma, but it has limited sensitivity that could only distinguish 69% of cases in the setting of well-differentiated liposarcoma.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e Given that malignant tumor originated from cardiovascular required different consideration in treatment options, therefore we still encourage to do the biopsy before intervention to better weigh the risks and benefit of the surgical treatment.\u003c/p\u003e \u003cp\u003eIn our case, the cardiac CT and cardiac MRI didn\u0026rsquo;t specify the origin of the lipoma\u0026rsquo;s stalk; it was fully described by Elen, et al.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e Given the uncertainty of the tumor origin, we decided to not performed any extensive manipulation due to its probability of increasing surgical technique difficulty and postoperative morbidity or mortality. Two years after, the patient remains to shows no symptoms, and Cardiac MRI also shows no evidence of recurrence of the tumor or the stalk. This evidence certifies that it is not necessary to do any extensive manipulation or other surgical approaches to reach the origin of the stalk since lipoma is a very slow-growing tumor. Nevertheless, we still encourage to do throughout diagnostic approach before the procedure to define the whole mass\u0026rsquo; precise location. Extension of cardiac MRI to the cervical region or venography should be considered in any similar cases.\u003c/p\u003e \u003cp\u003eThe surgical approach in excising lipoma in SVC should be considered wisely with the support of adequate preoperative diagnostic. Extensive manipulation that could increase surgical technique difficulty or postoperative morbidity and mortality is not necessary since lipoma is a very slow-growing tumor.\u003c/p\u003e "},{"header":"Abbreviations","content":" \u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSVC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSuperior vena cava; TTE:Transthoracic echocardiography; RA:Right Atrium; CT:Computed tomography; MRI:Magnetic resonance imaging; TEE:Transesophageal echocardiography; IVC:Inferior vena cava; ECG:Electrocardiogram\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and constent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNot applicable.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent was obtained from the patient. \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe authors declare that they have no competing interests.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThere was no funding for this case report.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTri Wisesa Soetisna: \u003c/strong\u003e\u003ca href=\"mailto:[email protected]\"\[email protected]\u003c/a\u003e\u003cstrong\u003e: conceptualized, wrote the paper and reviewed the literature. Lisca Namretta: \u003c/strong\u003e\u003ca href=\"mailto:[email protected]\"\[email protected]\u003c/a\u003e\u003cstrong\u003e: wrote the manuscript and edited the paper. Bagus Ronidipta: \u003c/strong\u003e\u003ca href=\"mailto:[email protected]\"\[email protected]\u003c/a\u003e\u003cstrong\u003e: reviewed the literature. Elen Elen: \u003c/strong\u003e\u003ca href=\"mailto:[email protected]\"\[email protected]\u003c/a\u003e\u003cstrong\u003e: validated the data and reviewed the paper. \u003c/strong\u003eSunu Budhi Raharjo: \u003ca href=\"mailto:[email protected]\"\[email protected]\u003c/a\u003e: \u003cstrong\u003ereviewed and edited the paper. Amin Tjubandi: \u003c/strong\u003e\u003ca href=\"mailto:[email protected]\"\[email protected]\u003c/a\u003e\u003cstrong\u003e: supervised, reviewed the literature and edited the paper.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eTanyeli O, Dereli Y, Gormus N, Odev K. Primary Intravascular Lipoma of the Superior Vena Cava.\u0026nbsp;\u003cem\u003eBalkan Med J\u003c/em\u003e. 2015;32(3):333-334. doi:10.5152/balkanmedj.2015.15808.\u003c/li\u003e\n\u003cli\u003eSundaram N, Kulkarni R, Sultan I, Singh M. Surgical Resection of a Symptomatic Superior Vena Cava Lipoma: A Case Report and Literature Review.\u0026nbsp;\u003cem\u003eAnn Vasc Surg\u003c/em\u003e. 2021;71:535.e11-535.e15. doi:10.1016/j.avsg.2020.09.052.\u003c/li\u003e\n\u003cli\u003eDoyle Z, Wolford B, Morshedi M, Santillan C. Intravascular lipoma of the renal vein.\u0026nbsp;\u003cem\u003eBJR|case reports\u003c/em\u003e. 2015;1(2):20150072. doi:10.1259/bjrcr.20150072.\u003c/li\u003e\n\u003cli\u003eBravi M, Salvadei S, Scarponi P, Loforte A, Musumeci F, Gasbarrone L. Intravascular lipoma of the superior vena cava.\u0026nbsp;\u003cem\u003eIntern Emerg Med\u003c/em\u003e. 2011;7(1):79-81. doi:10.1007/s11739-011-0584-9.\u003c/li\u003e\n\u003cli\u003eD\u0026rsquo;Souza J, Shah R, Abbass A, Burt J, Goud A, Dahagam C. Invasive Cardiac Lipoma: a case report and review of literature.\u0026nbsp;\u003cem\u003eBMC Cardiovasc Disord\u003c/em\u003e. 2017;17(1). doi:10.1186/s12872-016-0465-2.\u003c/li\u003e\n\u003cli\u003eIsmail I, Al-Khafaji K, Mutyala M, Aggarwal S, Cotter W, Hakim H, Khosla S, Aora r. Cardiac Lipoma. J Community Hosp Intern Med Perspect. 2015;5(5):28449.\u003c/li\u003e\n\u003cli\u003eAmano J, Nakayama J, Yoshimura Y, Ikeda U. Clinical classification of cardiovascular tumors and tumor-like lesions, and its incidences [published correction appears in Gen Thorac Cardiovasc Surg. 2013 Aug;61(8):448].\u0026nbsp;\u003cem\u003eGen Thorac Cardiovasc Surg\u003c/em\u003e. 2013;61(8):435-447. doi:10.1007/s11748-013-0214-8.\u003c/li\u003e\n\u003cli\u003eO'Donnell PW, Griffin AM, Eward WC, et al. Can Experienced Observers Differentiate between Lipoma and Well-Differentiated Liposarcoma Using Only MRI?.\u0026nbsp;\u003cem\u003eSarcoma\u003c/em\u003e. 2013;2013:982784. doi:10.1155/2013/982784.\u003c/li\u003e\n\u003cli\u003eElen E, D\u0026rsquo;Angelo T, Tjubandi A, Raharjo S. A rare case of superior vena cava lipoma: its presentation from non-invasive examination. European Heart Journal - Cardiovascular Imaging. 2019;20(10):1183-1183.\u003c/li\u003e\n\u003cli\u003eVinnicombe S, Wilson A, Morgan R, Saunders K. Intravascular Lipoma of the Superior Vena Cava. Journal of Computer Assisted Tomography. 1994;18(5):824-827.\u003c/li\u003e\n\u003cli\u003eThorogood S, Maskell G. Intravascular lipoma of the superior vena cava\u0026mdash;CT and MRI appearances. The British Journal of Radiology. 1996;69(826):963-964.\u003c/li\u003e\n\u003cli\u003eMordant P, Mercier O, Fadel E, Muniappan A, Fabre D, Chataigner O et al. Surgical resection of an intravascular superior vena cava primary lipoma. The Journal of Thoracic and Cardiovascular Surgery. 2010;140(6):1437-1438.\u003c/li\u003e\n\u003cli\u003eConcatto N, Camargo S, Camargo J, Hochhegger B, Irion K, Marchiori E. Superior Vena Cava Lipoma in an Asymptomatic Man. Lung. 2015;193(5):847-849.\u003c/li\u003e\n\u003cli\u003eWahab A, Chaudhary S, Munir A, Smith S. Lipoma of superior vena cava: a rare occurrence. BMJ Case Reports. 2017;:bcr-2017-220641.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Lipoma, Superior Vena Cava, Intravascular Tumor","lastPublishedDoi":"10.21203/rs.3.rs-542232/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-542232/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eIntravascular lipomas were a rare occurrence, especially in major vessels. This tumor is composed of adipocytes in a fibrous capsule that had a slow growth rate and usually shows no symptoms. There were only eight reports in the literature regarding intravascular lipoma located in the superior vena cava.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCase presentation:\u0026nbsp;\u003c/strong\u003eA 54-year-old man had episodes of supraventricular tachycardia and atrial flutter for over a year. Radiological findings preoperative showed a giant mass that arose from superior vena cava to right atrium and biopsy catheter showed that there were no signs of malignancy. The patient then underwent surgery through a median sternotomy and the mass was extirpated on the highest part of the stalk that could be reached. The patient was stable and remains to show no symptoms or evidence of residual mass or stalk in 2 years follow-up.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion:\u0026nbsp;\u003c/strong\u003eThe surgical approach in excising lipoma in SVC should be considered wisely with the support of adequate preoperative diagnostic. Extensive manipulation that could increase surgical technique difficulty or postoperative morbidity and mortality is not necessary since lipoma is a very slow-growing tumor.\u003c/p\u003e","manuscriptTitle":"Giant Lipoma in Superior Vena Cava: A Case Report and Literature Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-05-28 19:31:48","doi":"10.21203/rs.3.rs-542232/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"74c151e7-b5bb-4caf-a890-b77bf1d9009f","owner":[],"postedDate":"May 28th, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":4654757,"name":"Cardiothoracic Surgery"},{"id":4654758,"name":"Cardiac \u0026 Cardiovascular Systems"}],"tags":[],"updatedAt":"2022-01-15T19:30:54+00:00","versionOfRecord":[],"versionCreatedAt":"2021-05-28 19:31:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-542232","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-542232","identity":"rs-542232","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}