Epipericardial fat necrosis (EFN), also known as pericardial or mediastinal fat necrosis, has until lately been considered an unusual cause of acute chest pain. Due to increased use of computed tomography (CT) and other imaging techniques, EFN is now believed to be an under-diagnosed cause of acute chest pain. We here present a patient with a short history of acute, left-sided pleuritic chest pain and dyspnoea, with total resolution of symptoms upon few days with nonsteroidal anti-inflammatory drugs (NSAIDs) treatment. Chest X-ray showed a paracardial opacity with ipsilateral pleural effusion, echocardiography revealed features of EFN, and CT scan demonstrated the cardinal lesion of EFN—an ovoid, fat-containing paracardial mass with surrounding inflammatory stranding. There was a near to full radiological resolution in 3 weeks.

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In 65 patients (36 men, 29 women; mean age 74 [43-90] years) obstructive jaundice caused by malignant biliary stenosis was treated by endoscopic retrograde insertion of a 10 or 12 F synthetic endoprosthesis. The rate of complications of the endoscopic intervention was 5% (n = 3), 30-day mortality rate was 11% (n = 7) and method-related mortality was 8% (n = 5). Good drainage was achieved in 39 of 41 patients (95%) with the 12 F endoprosthesis, and in 15 of 21 patients with a 10 F one (71%) (P less than 0.001). Renewed jaundice due to prosthesis occlusion occurred in 31 patients an average of 103 (11-350) days after placement. Interval until occlusion correlated with the site of the stenosis and the length of the endoprosthesis. Jaundice recurred earlier in patients with long prostheses and proximal biliary stenosis than in those with a short prosthesis and distal stenosis. In 20 patients with renewed jaundice the endoprosthesis was replaced endoscopically. At that time 13 of the patients had a cholangitis. Occlusion of the new endoprosthesis was more common in patients with cholangitis (9 of 13) than those without (2 of 7; P less than 0.05). These findings indicate that endoscopic biliary tract drainage should be performed with as short a 12 F endoprosthesis as possible. In view of the potential need for early change of endoprosthesis the biochemical parameters of cholestasis should be regularly monitored.

A herniation (with torsion) of the heart trough a dehiscent pericardial suture was observed on the second postoperative day after right-sided pneumonectomy, when shock symptoms developed. Chest x-ray was diagnostic and lead to rethoracotomy with successful reposition of the heart.--Another case showed an atypical bulge of the heart contour after pneumonectomy with partial pericardial resection. It was caused by pericardial fat, sutured on the defect for occlusion.

Gastrokirurgisk avdeling Stavanger universitetssjukehus og Avdeling for kvalitet og helseteknologi Universitetet i Stavanger Marcus T. T. Roalsø er lege i spesialisering og ph.d.-stipendiat. Forfatteren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. Gastromedisinsk avdeling Stavanger universitetssjukehus Lars Karlsen er spesialist i indremedisin og fordøyelsessykdommer og seksjonsoverlege. Forfatteren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. Radiologisk avdeling Stavanger universitetssjukehus Petr Buchmann er spesialist i radiologi og seksjonsoverlege. Forfatteren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. Avdeling for blod-og kreftsykdommer Stavanger universitetssjukehus Einar Haukås er spesialist i blodsykdommer og avdelingsoverlege. Forfatteren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter.