Pericardial fat necrosis

Case contributed by Melbourne Uni Radiology Masters


Severe central chest pain. Pulmonary embolism?

Patient Data

Age: 58-year-old
Gender: Female

CT pulmonary angiogram:

Post-contrast scan.

Good opacification of the pulmonary arterial system.

There is no evidence of pulmonary embolus to the subsegmental arterial level.

No pleural effusion. Apical pericardial thickening; adjacent fat is abnormal also.

No focal pulmonary parenchymal abnormality. Heart size is normal.


No CT evidence of pulmonary embolus.

Appearances are consistent with pericardial fat necrosis.

Case Discussion

Epipericardial fat necrosis is a rare self-limiting cause of an acute chest pain in otherwise healthy individuals. It occurs within the mediastinum outside the pericardium.

Patients present with an acute chest pain that may mimic other cardiopulmonary causes. 

The pathogenesis of epipericardial fat necrosis is unknown. 

On imaging, CT in particular:

  • 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.

Conservative managment with NSAID and follow-up is usually performed.

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