Background <p>Cardiac lipomas are rare, benign and encapsulated tumors composed of mature adipocytes. They are typically asymptomatic but can cause various complications and even sudden death. Management typically involves surgical resection and close monitoring, but clear indications for surgery are not well established.</p> Case summary <p>A 67-year-old Chinese female, with a history of cervical cancer surgery, was found to have a right atrial mass during routine chest computed tomography follow-ups. The patient was asymptomatic, although an electrocardiogram showed incomplete right bundle branch block. Over several years, the mass increased in size. Imaging studies revealed a well-defined, non-avid, fat-containing right atrial mass. The patient underwent successful surgical excision of the tumor, and postoperative pathology confirmed it was a lipoma. Her recovery was uneventful, and the incomplete right bundle branch block resolved.</p> Conclusions <p>Cardiac lipomas require individualized evaluation and management based on their size, location, and potential to cause complications. Immediate surgical intervention is not always necessary, particularly for asymptomatic cases. However, careful long-term follow-up is crucial, with surgery considered when there is evidence of tumor growth, arrhythmias, or other risk factors for complications.</p>