Pericardial fat necrosis: an infrequent cause of chest pain

A 53-year-old man came to our emergency department with acute chest pain of 3 days duration. The symptoms increased with postural changes and deep inspiration. Physical examination, laboratory findings, EKG, chest radiography and echocardiogram were normal. Chest CT showed a lesion adjacent to the pericardium with a low attenuation coefficient surrounded by a capsule of higher density that enhanced after administration of IV contrast material. An MRI examination performed confirmed the fatty content of the lesion with hypointense strands. The findings highly suggested and confirmed pericardial fat necrosis. The patient was treated with analgesics and the pain resolved in one week.

Pericardial fat necrosis is an uncommon and benign cause of chest pain, of unknown pathogenesis. The pathologic findings are similar to those found in the epiploic appendagitis, breast, pancreatitis or subcutaneous fat necrosis. It is a self-limited entity and the treatment is conservative. Typically presents as acute pleuritic chest pain in patients with laboratory data, ECG and chest Ray often normal. It can be diagnosed by identifying at the CT or MRI a well defined lesion of fatty content, with intrinsic and extrinsic soft-tissue stranding, involvement of the neighboring pericardium or pleura and, occasionally, pleural effusion. Current knowledge about this entity is based on case reports and small case series with imaging description in CT findings. The purpose of this case report is to show CT and MRI findings to help in the pericardial fat necrosis diagnosis and confirmation. Learning points: -In a patient with acute pleuritic chest pain and a normal chest radiograph, CT and MRI can diagnose pericardial fat necrosis. -Pericardial fat necrosis is a bening, rare and self - limited disease that can mimic a myocardial chest pain.

Pericardial fat necrosis is an infrequent, self limited and significant cause of chest pain, in spite of its benign characteristics.For patients seen in the emergency department with isolated acute chest pain, normal laboratory results, ECG and chest radiograph, chest CT is recommended to support a diagnosis of pericardial fat necrosis. MRI can help con confirm the diagnosis.

-Víctor Pineda, Jordi Andreu, José Cáceres, Xavier Merino, Diego Varona, Rosa DomínguezOronoz. Lesions of the Cardiophrenic Space: Findings at Cross-sectional Imaging. Radiographics 2007, Vol. 27, No. -Karina de Souza Giassi, A