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Weekly Chest CasesArchive of Old Cases

Case No : 1438 Date 2025-05-12

  • Courtesy of Jung Hee Hong / Keimyung University Dongsan Hospital
  • Age/Sex 32 / F
  • Chief ComplaintLeft side chest pain
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Epicardial fat necrosis
Radiologic Findings
Figure 1. Coronary CT obtained two years before shows a calcified nodule measuring approximately 6 mm in size with surrounding soft tissue infiltration at the left cardiophrenic angle.
Figure 2. A chest CT scan reveals a calcified nodule with surrounding rim calcifications and enhancing soft tissue infiltration at the left cardiophrenic angle.
Figure 3. The lesion is measures about 18 mm in diameter on the coronal image.
Brief Review
Epipericardial fat necrosis can occur in various locations within the body. It is commonly observed in the breast and has also been reported in peripancreatic fat in cases of pancreatitis, in epiploic appendagitis, and in subcutaneous fat.
The pathogenesis of epipericardial fat necrosis remains unclear. Trauma and ischemia are known to be associated with fat necrosis in systemic adipose tissue. The pathological features of epipericardial fat necrosis closely resemble those observed in fat necrosis of the epiploic appendages, omentum, and breast.
Reports of calcification associated with epipericardial fat necrosis are rare. However, in other organs such as the epiploic appendages, similar findings of calcified chronic fat necrosis have been documented in the literature. Chronic infarction of the epiploic appendages is often clinically silent and progresses to aseptic fat necrosis. Over time, infarcted epiploic appendages transform into heterogeneous masses with calcification. A calcified mass may represent a sequela of aseptic chronic fat necrosis, as seen in the epiploic appendages.
Epipericardial fat necrosis typically presents with acute chest pain that is self-limiting but may recur after several days. Symptoms generally resolve within several weeks.
The characteristic CT findings of epipericardial fat necrosis include an encapsulated fatty lesion accompanied by inflammatory changes such as dense strands, thickening of the adjacent pericardium, or both. These radiologic features, in conjunction with chest pain, strongly suggest a diagnosis of fat necrosis.
References
1. V Pineda, J Caceres, J Andreu, et al. Epipericardial fat necrosis: Radiologic Diagnosis and Follow-up. AJR 2005; 185: 1234-1236.
2. LEE, Bae Young; SONG, Kyung Sup. Calcified chronic pericardial fat necrosis in localized lipomatosis of pericardium. American Journal of Roentgenology, 2007, 188.1: W21-W24.
Keywords

No. of Applicants : 69

▶ Correct Answer : 41/69,  59.4%
  • - Funabashi General Hospital , Japan MANABU AKIMOTO
  • - , Japan SUZUNE TSUKAMOTO
  • - medical scanning , Japan HIROAKI ARAKAWA
  • - IUHW Narita Hospital , Japan ISSEI FUKUDA
  • - Shiga University of Medical Science , Japan AKITOSHI INOUE
  • - Kyoto University , Japan AKIHIKO SAKATA
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - Inje University Haeundae Paik Hospital , Korea (South) HYUNGIN PARK
  • - , Korea (South) DONG-HO BANG
  • - , Italy PAOLO BALDASSARI
  • - Teikyo University Hospital , Japan CHIAKI SATO
  • - , Korea (South) JIN YOUNG LEE
  • - Secomedic Hospital , Japan FUMINORI MIYOSHI
  • - Oita University, Faculty of Medicine , Japan FUMITO OKADA
  • - Seoul Medical Center , Korea (South) HYUK GI HONG
  • - Osaka University , Japan AKINORI HATA
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Inje University Pusan Paik Hospital , Korea (South) JIYEON HAN
  • - Ajou University Hospital , Korea (South) YOU NA KIM
  • - Other , Korea (South) CHAEHUN LIM
  • - Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
  • - , Japan SHUNJIRO NOGUCHI
  • - , Japan MARINO TANIGUCHI
  • - Jichi Medical University, School of Medicine , Japan MITSURU MATSUKI
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Shiga General Hospital , Japan YUSAKU MORIBATA
  • - Mie university , Japan SHIKO OKABE
  • - GHICL , France MANUEL TOLEDANO
  • - Dokkyo Medical University , Japan HIROAKI ARAKAWA
  • - Other , Korea (South) SEOL A LEE
  • - Kyung Hee University Medical Hospital , Korea (South) JEONG TAEK YOON
  • - CHA University, CHA Bundang Medical Center , Korea (South) HWANGSEON JU
  • - Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
  • - Fukuoka university , Japan KEISUKE SATO
  • - Kantou Rousai Hospital , Japan KAORU SUMIDA
  • - Matsunami General Hospital , Japan TARO TAKEDA
  • - , Japan YUMI MAEHARA
  • - Toyota Kosei Hospital , Japan YUKI HAYASHI
  • - The Catholic University of Korea Yoeuido St. Mary , Korea (South) CHAWOONG JEON
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - University of Yamanashi , Japan KOJIRO ONOHARA
▶ Correct Answer as Differential Diagnosis : 7/69,  10.1%
  • - Oita university , Japan AYUMI KAMEI
  • - Kyoto City Hospital , Japan YUSUKE UTSUNOMIYA
  • - University of Yamanashi , Japan TAKAAKI HASHIMOTO
  • - University of Yamanashi , Japan HIROYUKI MORISAKA
  • - , Japan YOSHIKI ISHII
  • - University of Yamanashi , Japan HIROAKI WATANABE
  • - Osaka metropolitan university Hospital , Japan TATSUSHI OURA
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