Epipericardial fat necrosis: an underdiagnosed condition

Giassi, Karina de Souza; Costa, André Nathan; Bachion, Guilherme Hipolito; Apanavicius, Andre; Filho, José Rodrigues; Kairalla, Ronaldo Adib; Lynch, David A.

doi:10.1259/bjrcr.20140118

Cited by 10 publications

(27 citation statements)

References 16 publications

(8 reference statements)

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“…A previous retrospective study reported this condition in 0.26% of all patients and 2.15% of patients with atypical chest pain who underwent chest CT in the emergency department . In this study, the mean patient age was 45 years, and men were more commonly affected than women . Most cases are not associated with trauma or infection.…”

Section: Discussionmentioning

confidence: 56%

Epipericardial fat necrosis as cause of chest pain in patient after heart transplantation

Cafezeiro

Lopes

Silva

et al. 2020

American Journal of Transplantation

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Epipericardial fat necrosis is an uncommon clinical condition of unknown etiology. It typically presents as acute pleuritic chest pain and should be differentiated from acute pulmonary embolism and acute coronary syndrome. This condition is diagnosed by characteristic chest computed tomography findings of an ovoid mediastinal fatty lesion with intrinsic and surrounding soft‐tissue stranding. Treatment of epipericardial fat necrosis includes the administration of anti‐inflammatory agents, and symptoms usually resolve within a few days after treatment initiation. This disease entity has rarely been reported since it was first described in 1957. Most current knowledge of epipericardial fat necrosis is based on case reports that describe this condition in previously healthy individuals. We present the case of a 39‐year‐old woman with a history of heart transplant, who presented with chest pain secondary to epipericardial fat necrosis. Serial computed tomography revealed lesion resolution after appropriate treatment.

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Section: Discussionmentioning

confidence: 56%

Epipericardial fat necrosis as cause of chest pain in patient after heart transplantation

Cafezeiro

Lopes

Silva

et al. 2020

American Journal of Transplantation

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“…3 So, it is not expectable that patients with EFN have a higher risk of coronary heart disease. 3 So, it is not expectable that patients with EFN have a higher risk of coronary heart disease.…”

Section: Discussionmentioning

confidence: 99%

“…3 No evidence-based treatment guidelines are available due to the rarity and benign behavior of the disease. In most cases, the adjacent pericardium is also thickened.…”

Section: Discussionmentioning

confidence: 99%

Epipericardial fat necrosis as a differential diagnosis of chest pain—A case report

et al. 2019

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Epipericardial fat necrosis (EFN) is an uncommon self-limiting benign condition that can present with substantial chest pain. The first case was reported by Jackson et al 1 in 1957 and since then only a few cases were reported. However, new imaging modalities have increased its diagnosis.Epipericardial fat necrosis should be suspected in a patient with severe precordial pain after life-threatening/ major differential diagnosis such as acute coronary syndrome, pulmonary embolism, acute pericarditis, or pneumonia have been ruled out. | C A S E REP ORTWe present a case of an otherwise healthy 42-year-old man who presented to the emergency department with severe nonradiating left-sided pleuritic chest pain for the previous 4 days, only partially relieved by analgesics. Patient denied other symptoms or history of previous infection. Physical examination was unremarkable; chest radiograph (CXR), electrocardiogram (ECG), and routine laboratory testing (including D-dimer and troponin) were unrevealing. Contrast-enhanced thorax CT showed an increased radiolucency and nodularity of anterior pericardial fat with nodular appearance consistent with EFN (Figure 1, panel A-B). The transthoracic echocardiogram showed normal dimensions of cardiac chambers and no wall motion abnormalities, without other significant findings. A cardiac magnetic resonance imaging (MRI) was then performed to better characterize this lesion. MRI confirmed a small nodular lesion (10 x 17 mm) with regular contours, externally to the pericardium, in relation to the apex of the right ventricle and the anterior thoracic wall. There was hypersignal on T1-and T2-weighted images with loss of signal in fat saturation sequences and no first-pass or late gadolinium enhancement. The mass was delimited from the remaining pericardiac fat by a regular halo that presented hypersignal in T2, late enhancement and did not saturate on fat saturation sequences (Figure 2, panel A-B).Combined anti-inflammatory therapy (with colchicine and nonsteroidal anti-inflamatory drugs (NSAID)) was started with favorable evolution. Since the symptoms did not recur, biopsy of the lesion was dismissed.At 3-and 6-month follow-up, the patient remained symptom-free. A follow-up CT was performed and showed a slight densification of the anterior mediastinum's fat in lesser degree than in the previous exam (Figure 3, panel A-B). AbstractEpipericardial fat necrosis (EFN) is an uncommon self-limiting benign condition that can present with substantial chest pain. We present a case of an otherwise healthy 42-year-old man who presented with severe chest pain in the emergency department. Initial cardiopulmonary workup was unrevealing. Contrast-enhanced thorax CT demonstrated an increased radiolucency and nodularity of anterior pericardial fat consistent with epipericardial fat necrosis. The transthoracic echocardiogram was normal, and cardiac magnetic resonance imaging confirmed the lesion. Combined anti-inflammatory therapy was started with favorable evolution. K E Y W O R D Schest pain, CT, epiper...

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“…Epipericardial fat necrosis is a self-limiting benign cause of acute chest pain with an unknown aetiology 1 2. As predisposing factors high positioned epipericardial fat and obesity have been mentioned.…”

Section: Answer: Bmentioning

confidence: 99%

A 39-year-old otherwise healthy female with acute chest pain

Hoesein

Swaans

2015

Heart

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Clinical introductionAn otherwise healthy 39-year-old female visited our emergency department because of acute chest pain worsening on breathing. The pain was more prominent on the left side of the thorax. Physical examination, routine laboratory testing and the ECG were normal. Troponin and d-dimer were in the normal range. Routine chest radiography and subsequently chest CT were performed (figure 1).QuestionWhat is the most likely cause of the acute chest pain?Acute myocardial infarctionEpipericardial fat necrosisPneumoniaPulmonary infarction For the question see page 540 For the answer see page 547

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Epipericardial fat necrosis: an underdiagnosed condition

Cited by 10 publications

References 16 publications

Epipericardial fat necrosis as cause of chest pain in patient after heart transplantation

Epipericardial fat necrosis as cause of chest pain in patient after heart transplantation

Epipericardial fat necrosis as a differential diagnosis of chest pain—A case report

A 39-year-old otherwise healthy female with acute chest pain

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