Epipericardial Fat Necrosis: A Case Report and a Review of the Literature

Abstract

Epipericardial fat necrosis (EFN), also known as pericardial or mediastinal fat necrosis, has until lately been considered an unusual cause of acute chest pain. Due to increased use of computed tomography (CT) and other imaging techniques, EFN is now believed to be an under-diagnosed cause of acute chest pain. We here present a patient with a short history of acute, left-sided pleuritic chest pain and dyspnoea, with total resolution of symptoms upon few days with nonsteroidal anti-inflammatory drugs (NSAIDs) treatment. Chest X-ray showed a paracardial opacity with ipsilateral pleural effusion, echocardiography revealed features of EFN, and CT scan demonstrated the cardinal lesion of EFN-an ovoid, fat-containing paracardial mass with surrounding inflammatory stranding. There was a near to full radiological resolution in 3 weeks.

Keywords: Epipericardial fat necrosis; acute chest pain; chest pain; fat necrosis; mediastinal fat necrosis; pericardial fat necrosis; pleuritic chest pain.

Figure 1.

Opacity in basal part of left lung (black arrow) resulting in diminished left heart border and small amount of pleural effusion (white arrow) (A). Same opacity in sagittal view of chest (B).

Figure 2.

Chest CT scan in axial view with inflammatory stranding around an ovoid structure of fat density (circle), atelectasis in an adjacent part of the left lung and a small amount of left-sided pleural effusion (arrow) (A). Same ovoid structure seen in axial lung window (B) and in coronal views as well (C and D). CT indicates computed tomography.

Figure 3.

Parasternal long axis demonstrating highly echogenic pericardium covering the inferolateral wall of the left ventricle (whole arrow) and a hypoechogenic area in front of it (dotted arrow) (A). Parasternal short axis showing the same features as long axis (B). Apical 4-chamber view showing highly echogenic pericardium covering the lateral wall of left ventricle (C).

Figure 4.

Follow-up study with cardiac MRI 3 weeks after the initial presentation showed slightly coarse pattern of the fat tissue. Shown are coronal (A) and axial (B) T2 views. MRI indicates magnetic resonance imaging.