Epipericardial Fat Necrosis Research Articles

Cardiac PET and CMR in Diagnosis of Epi-pericardial Fat Necrosis Associated with Severe Refractory Chest Pain Following Arrhythmia Ablation

Cardiac PET and CMR in Diagnosis of Epi-pericardial Fat Necrosis Associated with Severe Refractory Chest Pain Following Arrhythmia Ablation

Epipericardial Fat Necrosis and Covid-19.

Epipericardial fat necrosis (EFN) is a rare and self-limiting cause of acute chest pain. We describe a case of EFN in a patient with a recent coronavirus disease (COVID-19). A 55-year-old male presented with a sudden onset of left-sided pleuritic chest pain for the past two days. The patient was diaphoretic, tachypneic, and tachycardic. Acute coronary syndrome was ruled out. A computed tomography (CT) pulmonary angiogram revealed an ovoid encapsulated fatty mass surrounded by dense appearing tissue. Patient symptoms improved remarkably with a short course of non-steroidal anti-inflammatory drugs (NSAIDs). EFN typically presents with a sudden onset of excruciating chest pain. Misdiagnosis, under-diagnosis, and mismanagement are unavoidable. EFN is incidentally diagnosed on CT scan. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infects visceral adipose tissue and appears to increase the risk of EFN by promoting inflammatory cytokine production and death of adipocytes. EFN is a rare cause of acute chest pain. SARS-CoV-2 is likely to induce EFN. This rare clinical entity should be considered in the differential of acute chest pain especially in patients with active or recent COVID-19. Epipericardial fat necrosis (EFN) is a rare cause of acute pleuritic chest pain that is often misdiagnosed and mismanaged.SARS-CoV-2 can possibly increase the risk of EFN and this entity should be considered in the differential of chest pain, especially in patients with active or recent coronavirus disease (COVID-19).Clinician awareness of EFN and its potential association with COVID-19, can reduce unnecessary testing and emotional distress.

Epipericardial fat necrosis in chest CT and MRI: a case report of an unusual cause of chest pain associated with the initial diagnosis of undifferentiated connective tissue disease

BackgroundEpipericardial fat necrosis (EFN) is a benign and self-limited condition of unknown cause with a good prognosis, usually affecting otherwise healthy patients. Clinically, it presents with severe acute left pleuritic chest pain, often leading the patient to the Emergency Room (ER).Case presentationA 23-year-old male, smoker (5 pack-years), was evaluated in the ER due to left pleuritic chest pain, worsening with deep breathing and Valsalva maneuver. It was not associated with trauma and did not present other symptoms.The physical examination was unremarkable. The arterial blood gases while breathing room air and the laboratory tests, including D-dimers and high-sensitivity cardiac Troponin T, were normal. The chest radiograph, electrocardiogram, and transthoracic echocardiogram showed no abnormalities.A computed tomography (CT) pulmonary angiogram showed no signs of pulmonary embolism but depicted at the left cardiophrenic angle a focal 3 cm ovoid-shaped fat lesion with stranding and thin soft tissue margins, consistent with necrosis of the epicardial fat, which was confirmed by magnetic resonance (MRI) of the chest.The patient was medicated with ibuprofen and pantoprazole, with clinical improvement in four weeks. At a two-month follow-up, he was asymptomatic and presented radiologic resolution of the inflammatory changes of the epicardial fat of the left cardiophrenic angle on chest CT. Laboratory tests revealed positive antinuclear antibodies, positive anti-RNP antibody, and positive lupus anticoagulant. The patient complained of biphasic Raynaud’s phenomenon initiated five years ago, and a diagnosis of undifferentiated connective tissue disease (UCTD) was made.ConclusionsThis case report highlights the diagnosis of EFN as a rare and frequently unknown clinical condition, which should be considered in the differential diagnosis of acute chest pain. It can mimic emergent conditions such as pulmonary embolism, acute coronary syndrome, or acute pericarditis. The diagnosis is confirmed by CT of the thorax or MRI. The treatment is supportive and usually includes non-steroidal anti-inflammatory drugs. The association of EFN with UCTD has not been previously described in the medical literature.

EPIPERICARDIAL FAT NECROSIS.

Epipericardial fat necrosis (EFN) is a relatively rare benign disease that causes acute chest pain. A woman in her 20s presented with acute left shoulder and epigastric pain. One day before presentation, she had visited a cardiologist and an acute coronary syndrome had been ruled out. The pain worsened with deep inspiration. Chest computed tomography (CT) showed a soft-tissue attenuation lesion containing a fatty centre located in the epipericardial fat at the left cardiophrenic angle. Hence, EFN was diagnosed and the pain was resolved with loxoprofen. The lesion had disappeared on a follow-up chest CT scan. EFN is a rare benign disease that causes acute chest pain. Approximately 70-90% of EFN cases are misdiagnosed by clinicians as other diseases. In patients with acute chest pain, the correct diagnosis of EFN avoids unnecessary invasive investigations and reassures patients. Patients with epipericardial fat necrosis typically present with acute pleural chest pain without any associated symptoms.Characteristic CT findings of the encapsulated fatty pericardial lesion with a surrounding inflammatory reaction are key for the diagnosis of epipericardial fat necrosis.The correct diagnosis of epipericardial fat necrosis in patients with acute chest pain reassures them and avoids unnecessary invasive investigation.

Epipericardial fat necrosis: a case report of an underdiagnosed disease.

Epipericardial fat necrosis: a case report of an underdiagnosed disease.

Man with Pleuritic Chest Pain.

We describe a case of epipericardial fat necrosis. Epipericardial fat necrosis is an inflammatory condition in which the pericardial fat pad necrotizes resulting in surrounding inflammation. This condition mimics more ominous pathology in clinical presentation and radiographic findings. Management is supportive with oral analgesics.

Extensive Epipericardial Fat Necrosis in a Case of Metastatic Adenocarcinoma of Lung

Epipericardial fat necrosis is an uncommon benign and self-limiting condition that leads patients to the emergency department owing to the onset of acute pleuritic chest pain. Fat necrosis in adipose tissue can occur at various sites: in the breast and subcutaneous fat after trauma, peripancreatic fat in pancreatitis, and epiploicappendagitis.[1,2] Rarely, it may occur within the epipericardial fat. Since the first description by Jackson et al.,[3] only 35 cases have been published in the English literature, and extensive epipericardial fat necrosis (EFN) is currently described as an extremely rare disease.[4] The aetiology of EFN remains unknown, but some theories have been proposed to explain its origin. Acute torsion of a vascular pedicle is described in some cases, although the presence of a vascular pedicle has been described in only two patients who underwent surgery.[4] Furthermore, increased intrathoracic pressure due to heavy lifting or Valsalva's manoeuvre might trigger rapid changes in capillary pressure, leading to haemorrhagic necrosis, especially if pre-existing structural abnormalities of the adipose tissue, such as lipoma, hamartoma or lipomatosis, are present.[5] Both males and females are affected, and neither age predilections nor pre-disposing factors have been described.[4]

Epipericardial fat necrosis in a patient with sudden chest pain.

Epipericardial fat necrosis (EFN) may be considered in the differential diagnosis of chest pain. Clinicians should be kept in mind that EFN is self-limiting and is often followed up with imaging.

Epipericardial Fat Necrosis: A Retrospective Analysis in Japan.

Objective Epipericardial fat necrosis (EFN) has been considered to be a rare cause of acute chest pain, and especially important for emergency physicians. Chest computed tomography (CT) is often used for the diagnosis of EFN after excluding life-threatening states, such as acute coronary syndrome and pulmonary embolism. While the proportion of EFN patients who underwent chest CT in emergency departments is being clarified, little is still known about other departments in Japan. To investigate the proportion of EFN patients who underwent chest CT for acute chest pain in various departments. Methods Chest CT performed from January 2015 to July 2020 in Asahikawa Medical University Hospital in Japan was retrospectively analyzed in this study. All images were reviewed by two radiologists. Results There were 373 outpatients identified by a search using the word ‘chest pain’ who underwent chest CT. Eight patients satisfying the imaging criteria were diagnosed with EFN. The proportions of patients diagnosed with EFN were 10.7%, 4.8%, 2.8%, 0.9% and 0% in the departments of general medicine, cardiovascular surgery, emergency medicine, cardiovascular internal medicine and respiratory medicine, respectively. Only 12.5% of the patients were correctly diagnosed with EFN, and the other patients were treated for musculoskeletal symptoms, acute pericarditis or hypochondriasis. Conclusion EFN is not rare and is often overlooked in various departments. All physicians as well as emergency physicians should consider the possibility of EFN as the cause of pleuritic chest pain.

Two unusual fat-containing mediastinal entities: Pearls and pitfalls in imaging of Morgagni hernia and fat necrosis

This review focuses on 2 fat-containing entities in the mediastinum that may raise a diagnostic challenge: Morgagni's hernia and Epipericardial (mediastinal) fat necrosis. Familiarity with the typical imaging findings of these 2 entities is vital for the radiologist to recognize and accurately characterize unusual mediastinal pathological conditions.

Epipericardial Fat Necrosis: A Concise Review of Literature

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.

胸痛で救急外来を受診したepipericardial fat necrosisの1例(Epipericardial fat necrosis with chest pain in the emergency department: a case report)

要旨 epipericardial fat necrosis（EFN）は胸痛を来す比較的稀な疾患で，本邦での報告は極めて少ない。症例は50歳代の女性で，胸痛を主訴に救急外来を受診。身体所見や血液検査，12誘導心電図，胸部X線はいずれも非特異的所見のみを認めた。胸部CTを施行したところ前縦隔左側の心膜外脂肪内に脂肪織濃度の楕円形構造物を認め，EFNの所見に合致すると判断した。両側肺底部に間質影を認めた。胸痛の原因はEFNによる可能性が高いと考え，入院とし，鎮痛剤による疼痛コントロールを行ったところ，疼痛は次第に軽快し入院5日目に退院した。約3か月後のフォローアップCTでは心膜外脂肪の病変および肺間質影は消失していた。EFNはCTで特徴的な所見を認め，診断に有用である。胸痛はNSAIDsなどによる対症療法を行い，多くの例で数日～数週間で軽快する。呈示例では肺の間質影が消長をともにしていた点が特徴的であった。胸痛患者において，他の疾患が否定され，胸部CTにて特徴的な所見を認める場合，EFNを念頭に置くべきと考える。

Epipericardial Fat Pad Necrosis-A Rare Cause of Chest Pain in an Adolescent.

Epipericardial fat necrosis is a rare cause of acute pleuritic chest pain reported in approximately 40 cases. This diagnosis mimics a myocardial infarction, pulmonary embolism, or pericarditis; however, the cardiac enzymes and electrocardiogram are usually normal. We present the first reported case of epipericardial fat necrosis in an adolescent.

Epipericardial fat necrosis: Rare cause of chest pain in children

Epipericardial fat necrosis: Rare cause of chest pain in children

Epipericardial fat necrosis: increasing the rate of diagnosis by disseminating knowledge within a single institution.

Epipericardial fat necrosis: increasing the rate of diagnosis by disseminating knowledge within a single institution.

Mediastinal (Epipericardial) Fat Necrosis: An Overlooked and Little Known Cause of Acute Chest Pain Mimicking Acute Coronary Syndrome

Necrosis of the fat adjacent to the heart, referred to as pericardial fat necrosis, epipericardial fat necrosis, and mediastinal fat necrosis, is a rare, self-limited condition. It presents as a sudden onset of severe chest pain that mimics symptoms of pulmonary embolism and acute coronary syndrome. Computed tomography (CT) findings are quite typical and consist of a round- or oval-shaped mass-like lesion containing soft tissue and fat density components in the cardiophrenic space. Lack of familiarity with this condition has led in the past to surgical interventions to remove the mass-like mediastinal fat necrosis. Until the early 2000s, surgical removal of these lesions was deemed the treatment of choice, to exclude a neoplasm. However, the observation that the CT findings of the paracardiac mass resemble fat necrosis seen in other parts of the body and its involution on follow-up CT has led to the realization that the process is a benign and self-limiting one. A dramatic shift in the paradigm of treatment has ensued and surgical treatment is no longer advocated. Awareness of this condition is, therefore, vital so as to diagnose it accurately and avoid unnecessary future surgical interventions.

Epipericardial Fat Necrosis. An Important Differential Diagnosis of Chest Pain

Introduction Epipericardial fat necrosis (EPFN) is a rare, benign, and self-limiting condition, first described in 1957 by Jackson et al. Currently, there are only 33 cases described in the literature.– The pathophysiology of the disease remains uncertain. Likely predisposing factors include torsion of the vascular pedicle of adipose tissue, structural alterations that make the tissue more vulnerable and obesity, which, like the Valsalva maneuver, can lead to increased capillary pressure, causing hemorrhage into the adipose tissue. There are also reports [...]

Epipericardial Fat Necrosis as a Cause of Acute Chest Pain

Acute chest pain is one of the most common reasons for presentation to the emergency department. Although most etiologies of chest pain are easy to clinically ascertain with routine history, physical, and laboratory examinations, we present an important benign cause of acute chest pain that may mimic acute coronary syndrome.

Epipericardial Fat Necrosis: Who Should Be a Candidate?

The objectives of the present study were to estimate the frequency of epipericardial fat necrosis among patients undergoing chest CT for chest pain and to compare the clinical and laboratory data between patients with epipericardial fat necrosis and control subjects. A retrospective review of 7463 chest CT studies performed in the emergency department from July 2011 to December 2014 was conducted to collect data regarding patient demographic characteristics and CT findings. Twenty patients who had epipericardial fat necrosis diagnosed were defined as the main patient group. An age- and sex-matched control group was selected from patients with chest pain who underwent chest CT during the same period. Linear regression models were used to assess data, and statistical significance was expressed as p values and 95% CIs. We found that the frequency of epipericardial fat necrosis was 2.15% among patients who underwent chest CT for chest pain. Epipericardial fat necrosis was statistically significantly associated with a lack of medication use (p = 0.01; 95% CI, -3.33 to -0.40) and the absence of other symptoms (p = 0.005; 95% CI, -5.83 to -1.27). Epipericardial fat necrosis was most often observed as an ovoid lesion with mixed fat attenuation with little stranding in the left paracardiac region accompanied by pleural effusion. Epipericardial fat necrosis is a significant clinical condition. For patients seen in the emergency department with isolated acute chest pain but no additional clinical history, no medication history, and normal laboratory results, chest CT is recommended to support a diagnosis of epipericardial fat necrosis.

Epipericardial fat necrosis: an underdiagnosed condition

Epipericardial fat necrosis: an underdiagnosed condition