Epipericardial Fat Necrosis: A Retrospective Analysis in Japan

Abstract

Objective Epipericardial fat necrosis (EFN) has been considered to be a rare cause of acute chest pain, and especially important for emergency physicians. Chest computed tomography (CT) is often used for the diagnosis of EFN after excluding life-threatening states, such as acute coronary syndrome and pulmonary embolism. While the proportion of EFN patients who underwent chest CT in emergency departments is being clarified, little is still known about other departments in Japan. To investigate the proportion of EFN patients who underwent chest CT for acute chest pain in various departments. Methods Chest CT performed from January 2015 to July 2020 in Asahikawa Medical University Hospital in Japan was retrospectively analyzed in this study. All images were reviewed by two radiologists. Results There were 373 outpatients identified by a search using the word 'chest pain' who underwent chest CT. Eight patients satisfying the imaging criteria were diagnosed with EFN. The proportions of patients diagnosed with EFN were 10.7%, 4.8%, 2.8%, 0.9% and 0% in the departments of general medicine, cardiovascular surgery, emergency medicine, cardiovascular internal medicine and respiratory medicine, respectively. Only 12.5% of the patients were correctly diagnosed with EFN, and the other patients were treated for musculoskeletal symptoms, acute pericarditis or hypochondriasis. Conclusion EFN is not rare and is often overlooked in various departments. All physicians as well as emergency physicians should consider the possibility of EFN as the cause of pleuritic chest pain.

Keywords: chest CT; emergency medicine; epipericardial fat necrosis; pleuritic chest pain.

Figure 1.

Chest CT diagnosed as EFN (patient No. 7). A: Chest CT shows an increased CT value of the epipericardial fat (red arrow) at the left cardiophrenic angle. B: Follow-up chest CT after two months showed drastic resolution in the necrotic area.

Figure 2.

The number of patients diagnosed with epipericardial fat necrosis in each department. Eight outpatients satisfying the imaging criteria were diagnosed with EFN. EFN findings were shown in three, three, one, one and no outpatients in the departments of general medicine, emergency medicine, cardiovascular internal medicine, cardiovascular surgery and respiratory medicine, respectively.