Fatty Images of the Heart: Spectrum of Normal and Pathological Findings by Computed Tomography and Cardiac Magnetic Resonance Imaging

Table 1

Differentiating features between physiologic and pathologic cardiac fat.

Type of fat	Patient’s characteristics	Cardiac location	Intramyocardial distribution	Morphological imaging pattern	Myocardial thickness	Ventricular size
Physiologic	Elderly, also without any cardiac disease associated	More in the RV than in LV: RV free wall, RVOT, RV and LV trabeculae, RV moderator band, interventricular septum, RV apex	Mostly subepicardial, sometimes with full thickness	Linear or patchy	Normal or thickened	Normal
ARVC	Young to middle age, male dominant	RV free wall, RVOT, RV apex, interventricular septum, LV lateral wall	Mostly subepicardial	Linear or patchy	Thinned	Enlarged RV, enlarged LV in left-dominant disease
PILM	Elderly or middle age, generally male dominant, within a chronic MI	Usually in LV myocardium, within a chronic MI scar, in a coronary artery irroration territory	Mostly subendocardial	Linear	Thinned, sometimes with calcifications	Normal or enlarged LV
DCM	Elderly or middle age	In LV myocardium, following myocardial fibrosis distribution	Mesocardial, sparing the subendocardium, not in a coronary artery irroration territory	Linear	Thinned or normal	Enlarged LV
LHIAS	Elderly or middle age, female dominant	Interatrial septum, sparing the fossa ovalis	Transmural in the interatrial septum	Lobular	Thickened interatrial septum (usually >2 cm in transverse diameter)	Normal

ARVC: arrhythmogenic right ventricular cardiomyopathy; PILM: postmyocardial infarction lipomatous metaplasia; DCM: dilatative cardiomyopathy; LHIAS: lipomatous hypertrophy of the interatrial septum; MI: myocardial infarction; RV: right ventricle; LV: left ventricle; RVOT: right ventricular outflow tract. Note. Readapted from Kimura et al. [2].