Acute epicardial fat necrosis

Case contributed by Dr Andrew Dixon

Presentation

Severe left pleuritic chest pain. ?Pulmonary embolus.

Patient Data

Age: 55 years
Gender: Male

The left epicardial fat is abnormally stranded and contains an encapsulated 4 cm ovoid fatty lesion at its lateral margin. A cluster of reactive lymph nodes are seen inferior to this lesion. A small left pleural effusion is present along with minor basal atelectasis. No pulmonary embolus seen. Absent spleen. 

Annotated image

Epicardial fat necrosis - the left epicardial fat pad shows inflammatory stranding (blue arrow) and contains an ovoid encapsulated fatty lesion (red arrow). A small reactive pleural effusion is seen. 

Case Discussion

Typical CT appearance of acute epicardial fat necrosis, a rare condition that clinically mimics other common causes of acute chest pain such as pulmonary embolism. The fat pad is inflamed and contains an ovoid encapsulated fatty lesion. It is common to see a small reactive ipsilateral pleural effusion. Management is usually conservative and the condition self-limiting.   

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