Pericardial fat tag sign

Case contributed by Assoc Prof Craig Hacking

Presentation

ICU patient.

Patient Data

Age: 35 years
Gender: Male
X-ray

ETT tip is projected in the proximal right main bronchus. NGT and left jugular CVL are well positioned.

Left deep sulcus sign and pericardial fat tag sign indicating a pneumothorax. Allowing for patient rotation, no signs of mediastinal shift.

CT

Pneumothorax confirmed on the left, with tags of pericardial fat at the cardiac apex hanging posteriorly. No mediastinal shift. Dependant LLL atelectasis.

Case Discussion

The pericardial fat pad sign is a nice but rare sign of pneumothorax on supine CXR. The pericardial fat displaces laterally as the lung is no longer adjacent to it pushing it against the mediastinum, hence causing a lumpy appearance of the cardiac borders.

Case courtesy of Dr Nivene Saad.

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