Epipericardial Fat Necrosis. An Important Differential Diagnosis of Chest Pain

Epipericardial Fat Necrosis: A Case Report and a Review of the Literature

“…Low specificity of symptoms, clinical findings, and blood tests 14 makes diagnostic imaging essential.…”

“…Recommendations for treatment and follow-up include a shorter period of nonsteroidal anti-inflammatory drugs (NSAIDs) 3 , 10 , 14 , 20 and a follow-up CT scan in 4 to 8 weeks to confirm healing and definitely exclude malignancies. 3 , 9 Most patients are pain free within the first week 1 , 14 , 17 , 21 and serial CT has shown partial or full resolution after 2 to 12 weeks. 8 , 9 , 11 , 22 , 23 Relapses are sometimes seen, 17 , 19 , 21 , 22 but reports of these are rare and prognosis is usually very good.…”

Epipericardial fat necrosis: Uncommon cause of acute pleuritic chest pain

“…EPFN may be clinically mistaken for other severe etiologies of pleuritic chest pain and dyspnea, most notably acute myocardial infarction and pulmonary thromboembolism [7] . However, laboratory values and electrocardiogram in EPFN are usually normal in an otherwise healthy patient, which can help guide clinicians to the correct diagnosis in the appropriate clinical setting.…”

“…However, when diagnostic question remains, the definitive diagnosis is attained by histopathological analysis from surgical resection. This has fallen in disuse because of the high accuracy of radiologic characteristics and benign self-limiting nature of the condition [7] . When performed, however, the pathologic features closely resemble epiploic appendagitis with a central focus of necrotic adipose cells encompassed by macrophages and neutrophils.…”

“…It is important for clinicians to be familiar of this disease process in order to manage it properly in the acute clinical setting. Due to the benign, self-limited nature, nonsteroidal anti-inflammatory drugs is indicated with surgical resection rarely performed for indeterminate cases [7] . Clinical follow-up and chest CT in 4 weeks may also be recommended to document resolution of symptoms and radiographic findings [5] .…”