Epipericardial fat necrosis
Updates to Article Attributes
Epipericardial fat necrosis is a rare self-limiting cause of an acute chest pain in an otherwise healthy individualsindividual. It occurs within the mediastinum outside the pericardium.
Clinical presentation
The patient presents with an acute chest pain that may mimic other cardiopulmonary causes. It is a self-limiting pain, ipsilateral to the lesion, which is more commonly on the left side (can be right-sided). The pain may eventually persist for several weeks. Syncope, tachycardia, dyspnoea have also been reported. On physical examination, a pericardial friction rub may be heard. Laboratory findings will be normal.
Pathology
The pathogenesis of epipericardial fat necrosis is unknown. Some predisposing factors have been mentioned in the literature:
- trauma
- ischaemia due to an acute torsion
- high positioned epipericardial fat
- obesity
- increased thoracic pressure related to the Valsalva maneuver may increase the capillary pressure, which leads to haemorrhagic necrosis
Radiographic features
Radiograph
- juxtacardiac opacity near the cardiophrenic angle with or without pleural effusion
CT
ovoid encapsulated mediastinal (epipericardial) fatty lesion with soft tissue rim and intrinsic and surrounding soft tissue stranding
thickened adjacent epicardium
Findings are similar to that observed with epiploic appendagitis and omental torsion in the peritoneal space.
Treatment and prognosis
Conservative management with non-steroidal anti-inflammatory agents and follow-up is usually performed.
Differential diagnosis
Possible differential considerations include:
- pericardial/epicardial lipoma
- pericardial/epicardial liposarcoma
- thymolipoma
- diaphragmatic hernia
-<p><strong>Epipericardial fat necrosis</strong> is a rare self-limiting cause of an acute chest pain in an otherwise healthy individuals. It occurs within the <a href="/articles/mediastinum">mediastinum</a> outside the <a href="/articles/pericardium">pericardium</a>.</p><h4>Clinical presentation</h4><p>The patient presents with an acute chest pain that may mimic other cardiopulmonary causes. It is a self-limiting pain, ipsilateral to the lesion which is more commonly on the left side (can be right-sided). The pain may eventually persist for several weeks. Syncope, tachycardia, dyspnoea have also been reported. On physical examination, a pericardial friction rub may be heard. Laboratory findings will be normal.</p><h4>Pathology</h4><p>The pathogenesis of epipericardial fat necrosis is unknown. Some predisposing factors have been mentioned in the literature:</p><ul>- +<p><strong>Epipericardial fat necrosis</strong> is a rare self-limiting cause of acute chest pain in an otherwise healthy individual. It occurs within the <a href="/articles/mediastinum">mediastinum</a> outside the <a href="/articles/pericardium">pericardium</a>.</p><h4>Clinical presentation</h4><p>The patient presents with an acute chest pain that may mimic other cardiopulmonary causes. It is a self-limiting pain, ipsilateral to the lesion, which is more commonly on the left side (can be right-sided). The pain may persist for several weeks. Syncope, tachycardia, dyspnoea have also been reported. On physical examination, a pericardial friction rub may be heard. Laboratory findings will be normal.</p><h4>Pathology</h4><p>The pathogenesis of epipericardial fat necrosis is unknown. Some predisposing factors have been mentioned in the literature:</p><ul>
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