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Weekly Chest CasesCases by Disease Category

Case No : 1284 Date 2022-05-31

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  • Courtesy of Mi Jung Park / Gyeongsang National University Hospital
  • Age/Sex 40 / F
  • Chief ComplaintLeft chest pain for 3 days
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Epipericardial fat necrosis
Radiologic Findings
Fig 1. Chest PA shows no definite abnormality in the chest.
Fig 2-5. CT scans reveal a fat-containing lesion with high-density fat stranding in the anterior aspect of the pericardium.
Brief Review
Epipericardial 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, and in subcutaneous fat.
The pathogenesis of epipericardial fat necrosis is unknown. Trauma and ischemia are associated with fat necrosis in systemic adipose tissue. Acute torsion has been proposed as the cause of ischemic necrosis of the epipericardiac fat, although the presence of a vascular pedicle has been described in only two cases. It has also been hypothesized that increased thoracic pressure related to a Valsalva maneuver may produce an elevation of capillary pressure that could lead to hemorrhagic necrosis.
The higher spatial resolution of modern CT scanners allows better characterization of the lesion and orientation of the diagnosis. 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. These findings with chest pain are highly suggestive features of fat necrosis.
Epipericardial fat necrosis is usually self-limiting and sometimes recurs several days later. Symptoms usually last several weeks.
References
Pineda V, C
Keywords

No. of Applicants : 103

▶ Correct Answer : 81/103,  78.6%
  • - Wakayama Red Cross Hospital , Japan TOMOAKI OTANI
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - , Japan HIROAKI ARAKAWA
  • - Jichi Medical University Hospital , Japan JUN KANZAWA
  • - ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
  • - Mayo Clinic , United States AKITOSHI INOUE
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - , Canada ASHISH GUPTA
  • - CHCB , France LE GUEN RAPHAEL
  • - National Center of Neurology and Psychiatry , Japan MOTO NAKAYA
  • - Seoul National University Hospital , Korea (South) HYUNGIN PARK
  • - , Italy PAOLO BALDASSARI
  • - Tiger Gate Hospital , Japan SHIN-ICHI CHO
  • - , Japan CHIAKI SATO
  • - Ichinomiya Nishi Hospital , Japan CHIHIRO KIGUCHI
  • - , Korea (South) CHANGSU KIM
  • - Other , Korea (South) HWANGHEE JO
  • - Chungbuk National University Hospital , Korea (South) JIYUN KANG
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Ajou University Hospital , Korea (South) KYUNGMIN LEE
  • - Hallym University Dongtan Medical Center , Korea (South) KYOUNG YEON LEE
  • - Other , Korea (South) SEONGSU KANG
  • - Scans world , India PHILSON JOSEPH MUKKADA
  • - Chonbuk National University Hospital , Korea (South) YONG HWAN JO
  • - Chonbuk National University Hospital , Korea (South) JUNGHWAN KIM
  • - Osaka University , Japan AKINORI HATA
  • - Korea University Guro Hospital , Korea (South) HEEJUN PARK
  • - Chungnam National University Hospital , Korea (South) HYUN JAE LIM
  • - Japanese Red Cross Kyoto Daini Hospital , Japan HITOMI NAGANO
  • - Shimada General Medical Center , Japan HAYATO NOZAWA
  • - , Korea (South) MINJI KIM
  • - Soonchunhyang University Hospital Bucheon , Korea (South) HYEJOO PARK
  • - Other , Korea (South) HYEON IL CHOI
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Ajou University Hospital , Korea (South) MINJI KIM
  • - Inje University Pusan Paik Hospital , Korea (South) JIYEON HAN
  • - Gifu University Hospital , Japan Yo Kaneko
  • - McGill , Canada MUTAZ ADNAN KHAIRO
  • - Kyoto University Hospital , Japan YASUHISA KURATA
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - , Korea (South) CHAEHUN LIM
  • - , Korea (South) YEONG UK HWANG
  • - Other , Korea (South) SEUNGHYUN LIM
  • - Presbyterian Medical Center , Korea (South) HANLIM SONG
  • - Other , Korea (South) MARI A
  • - , United States HIROAKI TAKAHASHI
  • - Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
  • - , Japan SHUNJIRO NOGUCHI
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - Eskisehir Sehir Hastanesi , Turkey MURAT SAHIN
  • - , Qatar NABIL SHERIF MAHMOOD
  • - , United Arab Emirates NEHAR RANJAN CHAKRABORTY
  • - Osaka metropolitan university Hospital , Japan TATSUSHI OURA
  • - Azienda Ospedaliera di Cremona , Italy Pietro Sergio
  • - Martinique , France PAUL LEBERT
  • - GHICL , France MANUEL TOLEDANO
  • - Chonnam National University Hwasun Hospital , Korea (South) JEONG YEOP LEE
  • - Inje University Ilsan Paik Hospital , Korea (South) SOYEUN PARK
  • - Holy Family Hospital , India RAJESH GOTHI
  • - Osmania Medical College, Hyderabad , India PURUSHOTHAMA RAO TUMMALA
  • - Chonnam National University Hospital , Korea (South) KIM SANG GYUN
  • - Other , Korea (South) KYU-CHONG LEE
  • - Kyoto University Hospital , Japan SATOSHI IKEDA
  • - Nishida Hospital , Japan SHOJI OKUDA
  • - Chonbuk National University Hospital , Korea (South) MINJEE KIM
  • - Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Chonbuk National University Hospital , Korea (South) DONG HAN SHIN
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Nerimahikarigaoka hospital , Japan TAKANA HAYASHI
  • - Chonbuk National University Hospital , Korea (South) YOUNG JU SONG
  • - Gyeongsang National University Hospital , Korea (South) BYEONG JU KOO
  • - Sotiria Hospital, Athens , Greece VASILIOS TZILAS
  • - , Japan YUMI MAEHARA
  • - , Japan YUKI HAYASHI
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
  • - Chonbuk National University Hospital , Korea (South) HYEONG RYUN CHO
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Semi-Correct Answer : 1/103,  1.0%
  • - , France HALIMSKI STANISLAU
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