Pericardial fat necrosis

Pericardial fat necrosis is a rare self-limiting cause of acute chest pain in an otherwise healthy individual. 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 persist for several weeks. Syncope, tachycardia, dyspnea have also been reported. On physical examination, a pericardial friction rub may be heard. Laboratory findings will be normal.

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

  • trauma
  • ischemia due to an acute torsion
  • high positioned pericardial fat
  • obesity
  • increased thoracic pressure related to the Valsalva maneuver may increase the capillary pressure, which leads to hemorrhagic necrosis
  • juxtacardiac opacity near the cardiophrenic angle with or without pleural effusion
  • ovoid encapsulated mediastinal (pericardial) 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 non-steroidal anti-inflammatory agents and follow-up is usually performed.

Possible differential considerations include:

Share article

Article information

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

Support Radiopaedia and see fewer ads

Cases and figures

  • Case 1
    Drag here to reorder.
  • Case 2
    Drag here to reorder.
  • Updating… Please wait.

     Unable to process the form. Check for errors and try again.

     Thank you for updating your details.