MRI findings of epipericardial fat necrosis: As a rare cause of acute chest pain in a healthy man

Friedrich, Matthias G.

doi:10.1016/j.radcr.2022.04.013

Cited by 3 publications

(6 citation statements)

References 10 publications

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“…EFN has been reported in 0.26% of 7463 chest CT examinations and 2.15% of 926 patients who underwent chest CT because of atypical chest pain in the emergency department of 1 institution [1] . The etiologies of EFN are unclear, although acute torsion of avascular pedicle, increased intrathoracic pressure due to heavy lifting or Valsalva's maneuver leading to hemorrhagic necrosis, and trauma to structural abnormalities have been suggested [5 , 6] .…”

Section: Discussionmentioning

confidence: 99%

“…Patients with EFN present with acute and pleuritic chest pain, which is ipsilateral to the lesion and can mimic acute myocardial infarction, pulmonary embolism, pneumonia, or acute pericarditis [1] , [2] , [3] , 7] . Other symptoms include dyspnea, syncope, dizziness, tachycardia, and diaphoresis [3 , [6] , [7] , [8] . Patients with EFN typically have normal physical examination results, although high blood pressure and pericardial friction rub have been reported [1 , 7] .…”

Section: Discussionmentioning

confidence: 99%

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Epipericardial fat necrosis: A case report

Fukamatsu,

Nakamura,

Ippongi

et al. 2024

Radiology Case Reports

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Epipericardial fat necrosis: A case report

Fukamatsu,

Nakamura,

Ippongi

et al. 2024

Radiology Case Reports

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“…The chest radiograph is nonspecific and is usually normal in the first 48-72 hours, after which there may be seen a juxtacardiac opacity near the cardiophrenic angle on the side of the chest pain, located anteriorly and usually merging with the cardiac silhouette, with or without a pleural effusion [ 1 , 2 , 8 ]. Chest CT is the preferred modality for diagnosing EFN, localising the abnormality in cardiophrenic space, and density measurements allowing confident characterisation of abnormal epicardial fat [ 1 , 2 , 5 ]. Chest CT typically demonstrates a round or ovoid encapsulated mediastinal fat-containing lesion with thin soft tissue density margins, and inflammatory changes of fat stranding and thickening of the adjacent epicardium [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…Pleural effusion and adjacent subsegmental lung atelectasis can also be identified at the time of diagnosis [ 2 , 4 ]. Findings on MRI include a focal fatty lesion with increased signal in T2 fluid sensitive sequences in the acute phase [ 5 ]. Gallium scintigraphy may show increased gallium uptake in the pericardial fat [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…The diagnosis can be made with chest computed tomography (CT), which typically demonstrates a round or ovoid encapsulated mediastinal fat-containing lesion in the cardiophrenic space, with thin soft tissue density margins [ 2 , 5 ]. On magnetic resonance (MRI), there is a focal fatty lesion with increased signal in T2 fluid sensitive sequences in the acute phase [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

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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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Ectopic epipericardial fat necrosis: a case report

Yoshino,

Nakatsubo,

Ujiie

et al. 2024

surg case rep

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Background Epipericardial fat necrosis (EFN) is a rare disease in which local inflammation and necrosis occur in the adipose tissue surrounding the heart, particularly epicardial fat. Few cases of EFN in which surgical resection was performed have been reported. We report a case of EFN after surgical resection of a right extrapulmonary tumor, in which a malignant disease could not be excluded. Case presentation A 75-year-old male patient presented with fever and chest pain. A contrast-enhanced computed tomography scan of the chest revealed a lesion, 53 × 48 mm in size, with mixed fatty density spanning the middle and lower lobes of the right lung. Thoracic magnetic resonance imaging (MRI) revealed a mass with mixed fat and soft tissue density in the same area; the lesion was contiguous with pericardial fatty tissue. The tumor was diagnosed as a liposarcoma or teratocarcinoma based on imaging results; however, the possibility of lung cancer could not be excluded. Finally, EFN was diagnosed based on the postoperative histopathological examination. The patient underwent surgical resection of the suspected right extrapulmonary tumor. The intraoperative findings revealed a mediastinal mass contiguous with pericardial fat located between the middle and lower lobes. Intraoperative pathological examination of the lesion was performed using a needle biopsy; however, no definitive diagnosis was made. The tumor may have invaded the middle lobe of the right lung, and partial resection of the right lower lobe was performed in addition to resection of the middle lobe of the right lung. The patient was followed up every 3 months without adjuvant therapy. No recurrence was reported at 1 year after surgery. Conclusion EFN should be considered in the differential diagnosis of an extrapulmonary tumor when continuity with the pericardial space is observed on MRI or other imaging studies. Surgical resection is useful in the diagnosis and treatment of EFNs. Preoperative three-dimensional reconstructive imaging and MRI should be used to identify vascular structures and confirm the continuity of the lesion with the surrounding tissues to ensure safe and rapid tumor removal.

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MRI findings of epipericardial fat necrosis: As a rare cause of acute chest pain in a healthy man

Cited by 3 publications

References 10 publications

Epipericardial fat necrosis: A case report

Epipericardial fat necrosis: A case report

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

Ectopic epipericardial fat necrosis: a case report

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