Epipericardial fat necrosis
Updates to Article Attributes
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.
Clinical presentation
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.
Pathology
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
'smaneuver may increase the capillary pressure, which leads tohaemorragichaemorrhagic necrosis
Radiographic features
Conventrional radiography
- 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.
Treatment
Conservative managment with NSAID and follow-up is usually performed.
Differential diagnosis
Possible differential considerations include:
- pericardial/epicardial lipoma
- pericardial/epicardial liposarcoma
- thymolipoma
- diaphragmatic hernia
-<li>increased thoracic pressure related to Valsalva's maneuver may increase the capillary pressure, which leads to haemorragic necrosis</li>- +<li>increased thoracic pressure related to the <a title="Valsalva maneuver" href="/articles/valsalva-manoeuvre">Valsalva maneuver</a> may increase the capillary pressure, which leads to haemorrhagic necrosis</li>
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