Epipericardial Fat Necrosis: A Concise Review of Literature

Meer R Zafar,Sami Warraich,Syed Farrukh Mustafa,Areeba Altaf,Amir Shahbaz

doi:10.7759/cureus.13106

Abstract

Epipericardial fat necrosis (EFN) is an inflammatory process that occurs in the mediastinal fat surrounding the heart. It is a rare cause of acute chest pain and mimics more ominous clinical conditions such as acute coronary syndrome, aortic dissection, and pulmonary embolism. Clinicians are often not familiar with this condition due to its infrequent occurrence, and traditional textbooks of medicine and cardiology have not covered this topic adequately. In the past, EFN had been managed primarily with thoracotomy and surgical excision. This has changed with advances in imaging techniques and their more frequent utilization. Computed tomography (CT) of the chest is essential for the diagnosis of EFN as it allows for the evaluation of the nature and precise location of the lesion. Magnetic resonance imaging helps to differentiate EFN from other mediastinal fatty lesions such as lipomas or liposarcomas. The clinical presentation of acute chest pain along with CT findings of the encapsulated fatty pericardial lesion is adequate for diagnosis. Our review describes the emerging role of imaging in diagnosis and change in management over the last few years.

Highlights

BackgroundFat necrosis in systemic adipose tissue can occur at various sites: in the breast and subcutaneous fat after trauma, peripancreatic fat in pancreatitis, and epiploic appendagitis [1,2]
Epipericardial fat necrosis (EFN) is an inflammatory process that occurs within the epipericardial fat and leads to encapsulated fat necrosis [3]
It is an uncommon cause of acute chest pain and is a benign, self-limiting disease that mimics serious clinical conditions such as acute coronary syndrome and pulmonary embolism [4]

Summary

Introduction

Fat necrosis in systemic adipose tissue can occur at various sites: in the breast and subcutaneous fat after trauma, peripancreatic fat in pancreatitis, and epiploic appendagitis [1,2]. Lee et al described a similar lesion with high intensity on T1- and T2-weighted MRI imaging that had a low signal intensity in the peripheral rim and central dot-and-line area [23] These findings are similar to those seen in patients with epiploic appendagitis [26]. The boundary consists of dense collagenous tissue with scattered infiltration of lymphocytes [25,31] These findings are similar to those seen in fat necrosis in other body areas such as breast and epiploic appendages [31]. The clinical presentation of acute chest pain coupled with CT findings of the encapsulated fatty pericardial lesion with surrounding inflammatory reaction (pericardial thickening and dense strands) is sufficient for diagnosis by a qualified radiologist. There remains a role of thoracotomy and excision when the diagnosis remained uncertain and features suggestive of a thoracic neoplasm

Conclusions

Disclosures

Findings

11. Perrin MB