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Acute chest pain caused by pericardial fat necrosis
  1. D A F van den Heuvel1,
  2. H W van Es1,
  3. G A Cirkel2,
  4. W J W Bos2
  1. 1Department of Radiology, St Antonius Hospital, Nieuwegein, The Netherlands
  2. 2Department of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands
  1. Correspondence to Dr D A F van den Heuvel, MD, Koekoekslaan 1, 3430 EM, Nieuwegein, The Netherlands; d.van.den.heuvel{at}antonius.net

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A 55-year-old woman presented at the emergency department with acute pleuritic chest pain. The pain was located on the left side of the sternum. Her relevant medical history revealed gastro-oesophageal reflux disease. Physical examination, laboratory investigations and a plain chest radiograph were normal. The patient was thought to be suffering from gastro-oesophageal reflux disease and was treated with antacids. After 3 days she visited the outpatient clinic with the same complaints but now there was also shortness of breath. A CT-angiogram was performed to exclude a pulmonary embolism and to look for an alternative diagnosis. This showed pericardial fat necrosis (figure 1).

Figure 1

Contrast-enhanced axial CT images. (A) A lipoid mass in the left cardiophrenic space (arrow) surrounded by inflammatory changes. (B) Pericardial thickening (arrow) and pleural effusion.

Pericardial fat necrosis is an uncommon cause of acute pleuritic chest pain. It is a self-limiting benign disorder which sometimes presents as a pericardial mass. Its aetiology is unknown but pathology shows encapsulated fat necrosis as is found in epiploic appendagitis or fat necrosis in the omentum or breast. A plain chest radiograph can be normal or may show an increased opacity in the paracardial space. CT scan reveals a fatty lesion in the pericardial fat with surrounding inflammatory changes, pericardial and/or pleural thickening and occasionally pleural fluid.1 Because of its self-limiting nature treatment is conservative.2 Our patient was treated symptomatically with a non-steroidal anti-inflammatory drug and was free of symptoms at 4 weeks of follow-up.

Learning points

  • In a patient with acute pleuritic chest pain and a normal chest radiograph, CT can identify alternative diagnoses such as pericardial fat necrosis.

  • Pericardial fat necrosis has characteristic CT findings.

  • Pericardial fat necrosis is a self-limiting disease.

References

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Footnotes

  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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