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Weekly Chest CasesArchive of Old Cases

Case No : 681 Date 2010-11-15

  • Courtesy of Eun Sun Lee, Chang Hyun Lee / Seoul National University Hospital
  • Age/Sex 55 / M
  • Chief ComplaintChest discomfort
  • Figure 1
  • Figure 2
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Epipericardial fat necrosis
Radiologic Findings
Figure 1. The chest radiograph shows approximately 4cm well-demarcated mass with lobulating contour at Lt. paracardiac area.
Figrue 2. On precontrast chest CT image, approximately 4cm sized well defined fatty mass is noted in the Lt. cardiophrenic angle. The fat plane between myocardium and the fatty mass is well maintained.
Figure 3. Contrast-enhanced chest CT scan of the coronal planes. After contrast enhancement, this fatty mass was minimally enhanced.
Figure 4. An enlarged image shows a tiny peripheral calcification and inner non-fatty soft tissue stranding of the mass.
Brief Review
Fat necrosis can occur in various sites in an organism. It is common in the breast and has also been described in peripancreatic fat in cases of pancreatitis, in epiploic appendagitis, in the subcutaneous fat, and, less frequently, in the epipericardial fat. The pathogenesis of epipericardial fat necrosis is unknown. Trauma and ischemia are associated with fat necrosis in systemic adipose tissue. The pathologic features are similar to those found in fat necrosis in epiploic appendagitis, omentum, and breast.
Epipericardial fat necrosis debuts with acute chest pain, which is usually self-limiting and sometimes recurs several days later. Symptoms usually last several weeks.
Radiologic findings: Posteroanterior chest radiography usually shows a paracardiac opacity, occurring predominantly on the left side. Associated pleural effusion may occur. The main CT features in epipericardiac fat necrosis are an encapsulated fatty lesion with inflammatory changes such as dense strands, thickening of the adjacent pericardium, or both. Together with acute chest pain, these findings form a triad highly suggestive of the diagnosis of fat necrosis.
References
V Pineda, J Caceres, J Andreu, et al. Epipericardial fat necrosis: Radiologic Diagnosis and Follow-up. AJR 2005; 185: 1234-1236.
Keywords
Mediastinum, Pericardium, Non-infectious inflammation,

No. of Applicants : 111

▶ Correct Answer : 25/111,  22.5%
  • - Inha University Hospital , Korea (South) Ju Won Lee
  • - Goa Medical College , India Paresh Desai
  • - seoul national university hospital , Korea (South) Ijin Joo
  • - James Paget Hospital , U.K , United Kingdom nabil mahmood
  • - CHA Bundang hospital , Korea (South) Hyerin Kim
  • - Teleradiology solutions , India harish bhambore
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Hospital M�e de Deus , Brazil Thiago Bento da Silva
  • - 遺„ , Korea (South) Jiye Sim
  • - Univ. of Miami/Jackson Memorial , United States mantosh rattan
  • - Yonsei university Shinchon Severance hospital , Korea (South) Na-young Shin
  • - Chonnam university hospital , Korea (South) LEE JI HYUN
  • - Bundang CHA hospital , Korea (South) Jung Jin Young
  • - Hangang sacred heart hospital , Korea (South) You Mie Han
  • - Assam Medical college , India samudra borah
  • - McGill University Health Center , Canada Alexandre Semionov
  • - KHOO TECK PUAT HOSPITAL , Singapore SUMER SHIKHARE
  • - CH de la C�te Basque , France Paul ARDILOUZE
  • - Chonbuk National University Hospital , Korea (South) Sungkwan Kim
  • - Seoul Nationial University Bundang Hospital , Korea (South) Hee Seok Choi
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - Beaulieu clinic Geneva , Switzerland gilles GENIN
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - Chonnam national university hosipital , Korea (South) Byung chan Lee
  • - Chonnam National University , Korea (South) se hee Jung
▶ Correct Answer as Differential Diagnosis : 3/111,  2.7%
  • - Chonnam National University Hospital , Korea (South) Jung Hyun Kim
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - All India Institute of medical sciences , India Justin Moses
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