Presentation
Right-sided pleuritic chest pain. Small effusion seen on chest x-ray. ? cause for effusion.
Patient Data
- small right-sided pleural effusion
- compressive atelectasis of the right lower lobe
- no pneumothorax
- fat-density structure with central focus of hyperdensity located within the right-sided epicardial fat, associated fat stranding within the anterior mediastinal fat
- a few smaller soft tissue nodules are located just inferior to this, likely reactive lymph nodes
- small right-sided pleural effusion with compressive atelectasis of the right lower lobe
- hepatic steatosis noted within the partially imaged liver
- no pulmonary masses, no hilar or mediastinal lymphadenopathy
Case Discussion
This case illustrates a case of epicardial fat necrosis in an otherwise well young male. The patient was managed conservatively.
The lesion could be easily missed as it is near the end of the image stack and hidden low within the epicardial fat.
The fatty liver supports the diagnosis, as obesity is often a predisposing factor.
A unilateral pleural effusion is concerning for a malignant effusion in other clinical scenarios but the unremarkable appearances of the lungs, intra-thoracic lymph nodes and the patient demographic render a malignant effusion unlikely. The effusion and lower lobe collapse are likely reactive in this setting.
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