Presentation
Severe left pleuritic chest pain. ?Pulmonary embolus.
Patient Data
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The left epicardial fat is abnormally stranded and contains an encapsulated 4 cm ovoid fatty lesion at its lateral margin. A cluster of reactive lymph nodes are seen inferior to this lesion. A small left pleural effusion is present along with minor basal atelectasis. No pulmonary embolus seen. Absent spleen.
Epicardial fat necrosis - the left epicardial fat pad shows inflammatory stranding (blue arrow) and contains an ovoid encapsulated fatty lesion (red arrow). A small reactive pleural effusion is seen.
Case Discussion
Typical CT appearance of acute epicardial fat necrosis, a rare condition that clinically mimics other common causes of acute chest pain such as pulmonary embolism. The fat pad is inflamed and contains an ovoid encapsulated fatty lesion. It is common to see a small reactive ipsilateral pleural effusion. Management is usually conservative and the condition self-limiting.
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