Epicardial fat pad

Case contributed by Dr Ian Bickle


Female patient with chest pain and shortness of breath. CTPA performed to assess for a pulmonary embolus.

Patient Data

Age: 40 years old
Gender: Female

The appearances of the left cardiophrenic angle have an almost 'double' border.  The innner one representing the left ventricle (muscle) and the outer one the outline of the significant pericardial fat.

The patient is of larger body habitus as evidenced by the soft tissue of the patient extending past the outer limits of the film.


A significant amount of epicardial fat is clearly observed on the CT study, including that at the left cardiphrenic angle corresponding to the plain film.

Case Discussion

Correlating different imaging modalities can be hugely interesting and value, not just in diagnosis, but understanding the radiographic concepts of our profession.

Plain films have limitations -- one being that they can demonstrate only 4 natural densities, fat being one of these, being marginally more lucent than soft tissue.

This is well demonstated on the chest x-ray delineating the soft tissue (muscular) left heart border from the adjacent epicardial fat.

Internationally there is a growing number of patients with larger body habitus.  As clinical imagers this can be a challenge, limitating our radiological magicbox!

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Case information

rID: 26509
Published: 25th Dec 2013
Last edited: 15th Sep 2017
System: Chest, Cardiac
Inclusion in quiz mode: Included

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