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Case Report

Myocardial steatosis: An autopsy-discovered case

Aimé Sosthène Ouédraogo1,2  
,  
W Norbert Ramdé2,3
,  
FAHA Ido2,4
,  
I Savadogo5
,  
R Alexis Ouedraogo6
,  
S Ouattara4
,  
Aïda S Ouedraogo1
,  
WYC Nikiema1

1 Service d’anatomie pathologique, CHU de Bogodogo, Ouagadougou, Burkina Faso

2 UFR/SDS université Joseph KI-ZERBO, Ouagadougou, Burkina Faso

3 Service de médecine légale, CHU de Bogodogo, Ouagadougou, Burkina Faso

4 Service d’anatomie pathologique, CHU de Tingandogo, Ouagadougou, Burkina Faso

5 Service d’anatomie pathologique, CHUR de Ouahigouya, Ouahigouya, Burkina Faso

6 Service histologie embryologie cytogénétique et biologie de la reproduction, CHU de Bogodogo, Ouagadougou, Burkina Faso

Address correspondence to:

Aimé Sosthène Ouédraogo

Service d’anatomie pathologique, CHU de Bogodogo, Ouagadougou,

Burkina Faso

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Article ID: 100070Z11AO2023

doi: 10.5348/100070Z11AO2023CR

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How to cite this article

Ouédraogo AS, Ramdé WN, Ido FAHA, Savadogo I, Ouedraogo RA, Ouattara S, Ouedraogo AS, Nikiema WYC. Myocardial steatosis: An autopsy-discovered case. J Case Rep Images Pathol 2023;9(1):17–20.

ABSTRACT

Introduction: Myocardial steatosis, a poorly documented pathology, is characterized by the accumulation of abnormal amounts of triglycerides in the cardiomyocytes. Myocardial steatosis is generally asymptomatic, but it can be the cause of heart failure. It is primarily of hypoxic or metabolic origin.

Case Report: We report a case of postmortem diagnosis in a 53-year-old male patient, without known his pathological history, who was a victim of sudden death from abdominal pain. The autopsy revealed diffuse atheromatous cardiac, aortic, and hepatic lesions.

Conclusion: It is very common for myocardial steatosis to be diagnosed postmortem due to its nonspecific symptomatology. The risk of mortality and morbidity could be reduced through a healthy lifestyle and regular biological examination to identify risk factors.

Keywords: Cardiomyocyte, Pathological anatomy, Steatosis

Introduction

Steatosis or fatty degeneration is the abnormal accumulation of triglycerides in parenchymal cells. It is frequently observed in hepatocytes, which are significantly involved in lipid metabolism. Rarely, it is found in heart tissue, where it may be found in the epicardium, the endocardium, or the myocardium. Myocardial localization is the most severe type causing heart failure with a risk of sudden death [1]. The causes are usually hypoxic or metabolic. In this report, we describe a case discovered after an autopsy.

Case Report

A 53-year-old male patient without a known pathological history with class II obesity (Body Mass Index of 38) died suddenly as a result of abdominal pain. External examination of the body did not find any lesions of violence. The abdominal wall of the subcutaneous adipose tissue was thick and measured 3.5 cm thick at autopsy (Figure 1). Examination of the viscera revealed a pancreas in a state of necrosis on two-thirds of the organ and an aorta which is the site of raised, ulcerated, or calcified yellowish plaques characteristic of advanced lesions of atherosclerosis (Figure 2A and Figure 2B). The cardiac tissue presented a yellowish appearance due to fatty infiltration in certain places (Figure 3). The other viscera, liver, kidneys, and other organs were macroscopically healthy. Microscopic examination showed that the pancreatic tissue was the site of massive cytosteatonecrosis. The cardiomyocytes displayed lipomatous infiltration, dissociating the myocardial fibers in some places (Figure 4). Hepatocytes showed macro- and microvacuolar steatosis lesions associated with mild portal lymphocyte inflammatory infiltrate (Figure 5). At the level of the aorta, atherosclerotic lesions were observed, consisting essentially of foam cells, lymphocytes, and cholesterol crystals within a fibrosis.

Figure 1: Thick subcutaneous adipose tissue.

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Figure 2: Aortic arteriosclerosis: (A) ulcerated and calcified foci, (B) Aortic arteriosclerosis.

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Figure 3: Slice of heart section showing fatty infiltration of the wall.

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Figure 4: Myocardial steatosis. G400, H&E staining fatty infiltration of cardiomyocytes.

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Figure 5: Hepatic steatosis. G400, H&E staining hepatocytes with intracytoplasmic lipid vacuoles.

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Discussion

Steatosis or fatty degeneration is the abnormal accumulation of triglycerides in parenchymal cells. It is frequently observed in hepatocytes, which are strongly involved in lipid metabolism. The causes are multiple: toxic (alcohol, drugs), nutritional, metabolic (diabetes, obesity), hypoxic, or infectious (viral hepatitis C) [2]. In developed countries, its most common cause is alcoholism [2]. In the normal state, fatty acids from adipose tissue or food are transported to hepatocytes, where they are esterified into triglycerides. They are then converted into cholesterol or phospholipids or oxidized into ketone bodies. Other fatty acids can be synthesized from acetate. The release of triglycerides by hepatocytes takes place in the form of lipoproteins after their conjugation with apoproteins. The accumulation of triglycerides can be linked, depending on the etiology, to an anomaly at the level of each metabolic stage, from the entry of fatty acids to their exit in the form of lipoproteins: alcohol is toxic for the function of microsomal and mitochondrial hepatocytes, malnutrition decreases apoprotein synthesis, anoxia inhibits fatty acid oxidation, and fasting increases peripheral mobilization [2]. Myocardial localization is rare and associated with a significant risk of developing cardiovascular disease with the consequent possibility of sudden death [3]. Fatty infiltration of the myocardium could be the cause of heartbeat disorders with cardiocirculatory failure. The mechanisms of the occurrence of these arrhythmias have not yet been elucidated [4]. The incidence of myocardial steatosis is increased due to some other factors such as aging, female sex, obesity, insulin resistance, diabetes, and aortic atherosclerosis [5],[6],[7]. The multi-visceral localization of steatosis in our patient is consistent with a metabolic origin, caused by a lipid metabolism disorder. Prevention through the identification of risk factors remains the main challenge in the management of this disease [4].

Conclusion

Myocardial steatosis poses a challenge for antemortem diagnosis due to its non-specific symptomatology. A healthy lifestyle and regular biological examination of potential risk factors could contribute to the reduction of morbidity and mortality.

REFERENCES

1.

Tuzzolo A, Febres-Aldana CA, Poppiti R. Severe myocardial steatosis: Incidental finding or a significant anatomic substrate for sudden cardiac arrest? Am J Forensic Med Pathol 2020;41(1):42–7. [Pubmed]   Back to citation no. 1  

2.

Pluot M. Pathologie cellulaire, adaptation, surcharges cellulaires et vieillissement cellulaire. In: Cotran RS, Kumar V, Collins T, editors. Robbins Anatomie Pathologique. Padoue: Piccin; 2000.   Back to citation no. 1  

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Shimabukuro M. Cardiac adiposity and global cardiometabolic risk: New concept and clinical implication. Circ J 2009;73(1):27–34. [CrossRef] [Pubmed]   Back to citation no. 1  

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Jazayeri MA, Emert MP. Sudden cardiac death: Who is at risk? Med Clin North Am 2019;103(5):913–30. [CrossRef] [Pubmed]   Back to citation no. 1  

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Granér M, Siren R, Nyman K, et al. Cardiac steatosis associates with visceral obesity in nondiabetic obese men. J Clin Endocrinol Metab 2013;98(3):1189–97. [CrossRef] [Pubmed]   Back to citation no. 1  

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Basso C, Thiene G. Adipositas cordis, fatty infiltration of the right ventricle, and arrhythmogenic right ventricular cardiomyopathy. Just a matter of fat? Cardiovasc Pathol 2005;14(1):37–41. [CrossRef] [Pubmed]   Back to citation no. 1  

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Hori Y, Funabashi N, Uehara M, et al. Positive influence of aging on the occurrence of fat replacement in the right ventricular myocardium determined by multislice-CT in subjects with atherosclerosis. Int J Cardiol 2010;142(2):152–8. [CrossRef] [Pubmed]   Back to citation no. 1  

SUPPORTING INFORMATION

Author Contributions

Aimé Sosthène Ouédraogo - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

W Norbert Ramdé - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

FAHA Ido - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

I Savadogo - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

R Alexis Ouedraogo - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

S Ouattara - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Aïda S Ouedraogo - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

WYC Nikiema - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Guarantor of Submission

The corresponding author is the guarantor of submission.

Source of Support

None

Consent Statement

Written informed consent was obtained from the patient for publication of this article.

Data Availability

All relevant data are within the paper and its Supporting Information files.

Conflict of Interest

Authors declare no conflict of interest.

Copyright

© 2023 Aimé Sosthène Ouédraogo et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.


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