Epipericardial fat necrosis

Epipericardial fat necrosis is a rare self-limiting cause of an acute chest pain in an otherwise healthy individuals. It occurs within the mediastinum outside the pericardium.

The patient presents with an acute chest pain that may mimic other cardiopulmonary causes. It is a self-limiting pain, ipsilateral to the lesion which is more commonly on the left side (can be right-sided). The pain may eventually persist for several weeks. Syncope, tachycardia, dyspnoea have also been reported. On physical examination, a pericardial friction rub may be heard. Laboratory findings will be normal.

The pathogenesis of epipericardial fat necrosis is unknown. Some predisposing factors have been mentioned in the literature:

  • trauma
  • ischaemia due to an acute torsion
  • high positioned epipericardial fat
  • obesity
  • increased thoracic pressure related to the Valsalva maneuver may increase the capillary pressure, which leads to haemorrhagic necrosis
Radiograph
  • juxtacardiac opacity near the cardiophrenic angle with or without pleural effusion
CT
  • ovoid encapsulated mediastinal (epipericardial) fatty lesion with soft tissue rim and intrinsic and surrounding soft tissue stranding

  • thickened adjacent epicardium

Findings are similar to that observed with epiploic appendagitis and omental torsion in the peritoneal space.

Conservative management with NSAID and follow-up is usually performed.

Possible differential considerations include:

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Article Information

rID: 26361
System: Chest
Section: Pathology
Synonyms or Alternate Spellings:
  • Mediastinal fat necrosis
  • Pericardiac fat necrosis
  • Epiperi-cardial fat necrosis
  • Epicardial fat necrosis
  • Epicardial fat pad necrosis

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