Epipericardial Fat Necrosis: A Retrospective Analysis in Japan

Abstract

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.

Epipericardial fat necrosis

“…EFN is a rare benign disease that causes acute chest pain and was first described by Jackson et al in 1957 [ 1 ] . EFN is a self-limiting cause of acute chest pain [ 2 ] , which can be detected in 2.2–2.8% of chest CT scans performed for acute chest pain [ 3 , 4 ] . Patients with EFN typically present with acute pleural chest pain without associated symptoms [ 2 , 3 ] .…”

“…Hence, the characteristic CT findings of an encapsulated fatty pericardial lesion with surrounding inflammatory reactions are key for diagnosis [ 2 ] . Approximately 70–90% of EFN cases may be misdiagnosed by clinicians as other conditions [ 3 , 4 ] . The correct diagnosis of EFN is significant as it reassures patients and avoids over-investigation since there are broad differential diagnoses for acute epigastric pain (e.g., acute coronary syndrome, acute pericarditis, pulmonary thromboembolism, pneumonia, cholecystitis, cholangitis, peptic ulcer disease).…”

“…The correct diagnosis of EFN is significant as it reassures patients and avoids over-investigation since there are broad differential diagnoses for acute epigastric pain (e.g., acute coronary syndrome, acute pericarditis, pulmonary thromboembolism, pneumonia, cholecystitis, cholangitis, peptic ulcer disease). EFN usually resolves within 1–2 weeks without any specific treatment [ 2 ] , but a follow-up CT scan within 2–3 months may be recommended to exclude the possibility of a tumour [ 4 ] .…”

“…Approximately 70-90% of EFN cases may be misdiagnosed by clinicians as other conditions [3,4] . The correct diagnosis of…”

Ectopic epipericardial fat necrosis: a case report

“…Epipericardial fat necrosis (EFN) is a rare disease characterized by localized inflammation and necrosis of the adipose tissue surrounding the heart, especially the epicardial fat. This unique condition was first described in 1957, and there have since been few reports [1,2]. Few cases of EFN have been reported in which surgical resection was performed and histopathological examination led to a diagnosis.…”