Epipericardial fat necrosis: an uncommon self-limiting cause of pleuritic chest pain

Haq, Sana; Wilson, Mitchell P; Manca, Donna

doi:10.1503/cmaj.190703

Cited by 3 publications

(3 citation statements)

References 7 publications

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“…Cardiac work up including electrocardiograms and cardiac enzymes and other laboratory investigations are generally unremarkable [2], with the exception of minimal rise in inflammatory markers as was seen in one case [7]. Additionally, a mildly elevated D-dimer was described in 3 different cases [4,5,7].…”

Section: Clinical and Imaging Findingsmentioning

confidence: 89%

“…In a recent paper, it was suggested that the frequency of the radiologist properly reporting EPFN can be improved by increasing their awareness of the disease [7].…”

Section: Etiology and Demographicsmentioning

confidence: 99%

“…Prognosis is very good as this disease is self-limiting with symptoms generally clearing up within a few days and complete resolution of radiological findings is witnessed in the upcoming weeks to months [7].…”

Section: Treatment and Prognosismentioning

confidence: 99%

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Diagnosis of Epipericardial Fat Necrosis on multimodality imaging in a pediatric patient: a case report and review of the literature

Alomari

Khushaim

2020

Radiology Case

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This is a case report of a 13-year-old male, presented to the Emergency Department complaining of a sudden onset left-sided pleuritic chest pain for 1 day. He was found to have a mass in the left Epipericardial fat with fat stranding and pleural effusion supporting the diagnosis of Epipericardial Fat Necrosis. The findings were established by Computed tomography and Ultrasound, and the final diagnosis was confirmed by Magnetic resonance imaging. Subsequently, the patient was discharged on analgesia; reassessment one-month later showed clinical improvement with no symptom recurrence. Repeated Ultrasound demonstrated a marked decrease in size and echogenicity of the mass. In this paper we review the clinical and radiological manifestations of Epipericardial fat necrosis and the different management approaches taken over the years. CASE REPORTA 13-year-old male, presented to the Emergency Department complaining of a sudden onset left-sided chest pain for 1 day. The pain was pleuritic in nature and worsened upon lying down. The boy gave history of a mild trauma while playing hockey 2 days prior to his presentation, but no history of fever. Upon examination, he looked uncomfortable and had shallow respirations with normal vital signs. Auscultation of the chest revealed decreased air entry over the left side. Laboratory investigations showed slightly elevated White Blood Cell count (15.00 g/L), (normal range is between 5.0 to 10.0 g/L), minimal increase in Fibrinogen levels (4.88 g/L), (normal range is between 2.0 to 4.0 g/L), and significant increase in C-Reactive Protein (71.20 mg/L), (normal level is less than 10 mg/L). The patient was given Ibuprofen to relieve his pain and a chest x-ray (CXR) was ordered to rule out Pneumonia. Imaging findings:A posterior-anterior (PA) and lateral CXR was performed, PA view showed peripheral opacity involving the lower mid and inferior aspect of the left hemithorax (Figure 1a). The lateral costophrenic angle was clear. No airspace consolidation or pneumothorax. There were no rib changes. On the lateral view, there was a minimal undulation/thickening seen in the lower anterior chest (Figure 1b).

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Section: Clinical and Imaging Findingsmentioning

confidence: 89%

“…In a recent paper, it was suggested that the frequency of the radiologist properly reporting EPFN can be improved by increasing their awareness of the disease [7].…”

Section: Etiology and Demographicsmentioning

confidence: 99%

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Diagnosis of Epipericardial Fat Necrosis on multimodality imaging in a pediatric patient: a case report and review of the literature

Alomari

Khushaim

2020

Radiology Case

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Epipericardial fat necrosis in chest CT and MRI: a case report of an unusual cause of chest pain associated with the initial diagnosis of undifferentiated connective tissue disease

Barreto

Oliveira

Barreira

et al. 2023

BMC Cardiovasc Disord

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Background Epipericardial fat necrosis (EFN) is a benign and self-limited condition of unknown cause with a good prognosis, usually affecting otherwise healthy patients. Clinically, it presents with severe acute left pleuritic chest pain, often leading the patient to the Emergency Room (ER). Case presentation A 23-year-old male, smoker (5 pack-years), was evaluated in the ER due to left pleuritic chest pain, worsening with deep breathing and Valsalva maneuver. It was not associated with trauma and did not present other symptoms. The physical examination was unremarkable. The arterial blood gases while breathing room air and the laboratory tests, including D-dimers and high-sensitivity cardiac Troponin T, were normal. The chest radiograph, electrocardiogram, and transthoracic echocardiogram showed no abnormalities. A computed tomography (CT) pulmonary angiogram showed no signs of pulmonary embolism but depicted at the left cardiophrenic angle a focal 3 cm ovoid-shaped fat lesion with stranding and thin soft tissue margins, consistent with necrosis of the epicardial fat, which was confirmed by magnetic resonance (MRI) of the chest. The patient was medicated with ibuprofen and pantoprazole, with clinical improvement in four weeks. At a two-month follow-up, he was asymptomatic and presented radiologic resolution of the inflammatory changes of the epicardial fat of the left cardiophrenic angle on chest CT. Laboratory tests revealed positive antinuclear antibodies, positive anti-RNP antibody, and positive lupus anticoagulant. The patient complained of biphasic Raynaud’s phenomenon initiated five years ago, and a diagnosis of undifferentiated connective tissue disease (UCTD) was made. Conclusions This case report highlights the diagnosis of EFN as a rare and frequently unknown clinical condition, which should be considered in the differential diagnosis of acute chest pain. It can mimic emergent conditions such as pulmonary embolism, acute coronary syndrome, or acute pericarditis. The diagnosis is confirmed by CT of the thorax or MRI. The treatment is supportive and usually includes non-steroidal anti-inflammatory drugs. The association of EFN with UCTD has not been previously described in the medical literature.

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Epipericardial Fat Necrosis in a Pediatric Patient Diagnosed Using Contrast-Enhanced MRI Findings: A Case Report and Literature Review

Kim

Han

Cho

et al. 2022

J Korean Soc Radiol

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Epipericardial fat necrosis: an uncommon self-limiting cause of pleuritic chest pain

Cited by 3 publications

References 7 publications

Diagnosis of Epipericardial Fat Necrosis on multimodality imaging in a pediatric patient: a case report and review of the literature

Diagnosis of Epipericardial Fat Necrosis on multimodality imaging in a pediatric patient: a case report and review of the literature

Epipericardial fat necrosis in chest CT and MRI: a case report of an unusual cause of chest pain associated with the initial diagnosis of undifferentiated connective tissue disease

Epipericardial Fat Necrosis in a Pediatric Patient Diagnosed Using Contrast-Enhanced MRI Findings: A Case Report and Literature Review

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