Epipericardial Fat Necrosis: Who Should Be a Candidate?

Abstract

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 uncommon self-limiting cause of pleuritic chest pain

“…2 The diagnosis remains an underrecognized and misdiagnosed condition; a recent retrospective study of patients presenting to the emergency department with chest pain and subsequent CT found the frequency of epipericardial fat necrosis to be 2%. 3 • The condition often presents as acute pleuritic chest pain, usually left sided, resembling other serious conditions such as myocardial infarction, pulmonary embolism and pneumonia.…”

“…Proposed mechanisms have included torsion of a pedicle-like lesion, resulting in ischemia; and increased capillary pressures during a Valsalva manoeuvre, resulting in hemorrhage into the epipericardial fat. 3,5 The necrosis is centred within the epipericardium rather than the pericardium, implying that one of the terms previously used to describe this condition, "pericardial necrosis," is a misnomer. 5 The condition often presents as acute pleuritic chest pain, resembling other serious etiologies such as myocardial infarction, pulmonary embolism and pneumonia.…”

“…6 Pain is usually left sided and pleuritic, as the epipericardial fat at the left cardiophrenic angle is most often involved. 3 Radiation to the neck, shoulders and upper arm has been described. 6 The pain is frequently self-limited to only a few days but can last up to several weeks.…”

“…1,3 Historically, obesity had been considered a risk factor for epipericardial fat necrosis, but studies to date have failed to show an association between the 2 entities. 3,5,6 The patient may demonstrate diaphoresis, tachycardia or tachypnea; otherwise, the clinical examination is often noncontributory, with negative findings on cardiopulmonary and abdominal assessment. 1,7 Tenderness to palpation over the left anterior chest may be present.…”

“…5 A small reactive pleural effusion on the side of involved fat may also be present. 3 A chest CT is often the confirmatory test, demonstrating an ovoid encapsulated epipericardial fatty lesion with internal fat stranding. Regional inflammatory changes may be present, including stranding within the adjacent epipericardial fat, thickening of the adjacent pericardium and a small reactive pleural effusion.…”