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).

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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.