Lipomatous Hypertrophy of the Interatrial Septum

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Lipomatous hypertrophy of the interatrial septum is an exaggerated growth of normal fat existing within the septum and is not a true tumor. Rather, it is a developmental disorder caused by expansion of adipose tissue trapped in the interatrial septum during embryogenesis. The septal hypertrophy may be as large as 2 cm in thickness and is seen primarily in older patients and in those who are obese.

It has been suggested that this disorder is associated with the presence of coronary artery disease in proportion to the degree of atrial septal thickness (possibly true in this case although the patient is a vasculopath).

Lipomatous hypertrophy of the interatrial septum is indistinguishable from lipoma except that the former occurs in the atrial septum with a typical distribution (generally sparing the fossa ovalis). In the absence of symptoms of atrial arrhythmias, heart block, or rare vena caval obstruction, they do not require resection.

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Iatrogenesis Imperfecta: Errant Pedicle Screw Tip in Lung

Having never placed these myself, it must require a of lot hand wringing about where the screws are actually going. I have seen a screw perforate the T – cord from an operation in Greensboro, resulting in intractable pain.

For scoliosis patients, this is especially challenging since every level has a slightly different projection due to the curvature and rotation.

 

These cases give rise to so many questions such as what did the fluoroscopic view look like, did the patient get a pneumothorax, what is the tolerance of the pleura and lung to a penetrating screw?

I know from spinal procedures and joint injections that careful evaluation of the projection that can take minutes of fluoro is far better than the struggle associated with a bad approach.

 

 

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