Pericardial Fat Masquerading as Tumor

Abstract

A 65-year-old woman was evaluated for fatigue, malaise, and atypical chest pain. One year prior she had undergone subtotal gastrectomy and jejunostomy in treatment of a large gastrointestinal stromal tumor. Two-dimensional echocardiography was performed, which showed a small circumferential pericardial effusion with a soft tissue echo density attached to the right atrial/right ventricular junction that extended over the right ventricle. Because of concern about possible malignant disease, thoracoscopy and biopsy of the pericardial mass were recommended. Normal fibro-adipose tissue was found with no evidence of neoplasm. Pericardial fat deposition is common in multiple conditions. It can be found in any location but is most common over the anterior portion of the heart. In this case, the concomitant presence of a small pericardial effusion and prominent fat pad at the right atrial/right ventricular junction gave the appearance of pericardial tumor.

Value of Two‐Dimensional Speckle Tracking and Real Time Three‐Dimensional Echocardiography for the Identification of Subclinical Left Ventricular Dysfunction in Patients Referred for Routine Echocardiography

“…Resting two‐dimensional (2D) echocardiography is widely used today as a first line screening tool for detection of a wide variety of cardiac diseases such as valvular pathology, pericardial disease, congenital lesions, coronary artery disease (CAD), etc 1–5 . However, the assessment of myocardial dysfunction chiefly relies on wall motion analysis (WMA) and estimation of left ventricular ejection fraction (LV EF) which is subjective and limited by high observer variability 6 …”

Intrinsic and Extrinsic Cardiac Pseudotumors: Echocardiographic Evaluation and Review of the Literature

“…For example, an exclusively anterior location generally means fat, while an exclusively or predominantly posterior location is likely to represent fluid. One other clue that points toward fat as a cause of the echogenic structure is that fatty tissue is generally slightly more echogenic than fluid . The dilemma of delineating pericardial fat from fluid does occasionally arise in clinical practice; however, needing to distinguish pericardial fat (with or without associated fluid) from a solid mass is rare.…”

“…Even still, the convincing appearance of both pericardial fat and pericardial effusion pseudotumors has even led to surgery for a presumed malignancy in certain isolated cases. Albeit rare, the appearance of the pericardial fat can sometimes take on an unusual form and mimic pericardial tumor deposits clinically on echocardiography . It has been postulated that this phenomenon is likely due to the concomitant presence of a small effusion surrounding the pericardial fat in a localized area and increasing the intensity of echogenicity in that area, thus creating a mass‐like effect .…”

“…A commonly used echo definition of pericardial fat, or epicardial adipose tissue, is the echo-free space between the outer layer of the myocardial wall and the visceral layer of the pericardium. 40 Previously described predisposing conditions for increased pericardial fat deposition include male gender, chronic corticosteroid use, enhanced visceral adiposity, advanced age, obesity, and diabetes mellitus (DM) type II. 41,42 Pericardial fat is most commonly seen over the anterior portion of the heart, but it can be seen anywhere.…”

“…One other clue that points toward fat as a cause of the echogenic structure is that fatty tissue is generally slightly more echogenic than fluid. 40 The dilemma of delineating pericardial fat from fluid does occasionally arise in clinical practice; however, needing to distinguish pericardial fat (with or without associated fluid) from a solid mass is rare. Even still, the convincing appearance of both pericardial fat and pericardial effusion pseudotumors has even led to surgery for a presumed malignancy in certain isolated cases.…”