J Korean Soc Radiol.  2016 Apr;74(4):222-225. 10.3348/jksr.2016.74.4.222.

Ultrasonographic Findings of Epipericardial Fat Necrosis: A Case Report

• Park C
• Hwang HJ
• Lee K
• Lee IJ
• Park KH

• KMID: 2208778
• DOI: http://doi.org/10.3348/jksr.2016.74.4.222

Abstract

Epipericardial fat necrosis (EFN) is an infrequent cause of acute chest pain. In rare cases like these, conservative treatment is necessary. Clinically, EFN may mimic emergent cardiopulmonary conditions, such as acute myocardial infarction. Computed tomography (CT) and magnetic resonance imaging characteristics of EFN is well described as encapsulated fatty lesion with perilesional soft tissue strands and thickening of adjacent pericardium in the epipericardial area. For confirmation of the diagnosis, involution of this lesion on follow-up is important. We present a case of EFN observed with ultrasonography (USG). This lesion was shown as a well-defined ovoid shaped mass with heterogeneous echogenicity in the left side of cardiophrenic space on USG. There was no color flow on Doppler USG. Follow-up USG and CT revealed decrease in the size of the lesion.

MeSH Terms

Chest Pain
Diagnosis
Fat Necrosis*
Follow-Up Studies
Magnetic Resonance Imaging
Mediastinum
Myocardial Infarction
Pericardium
Ultrasonography
Ultrasonography, Doppler

Figure

• 

  Fig. 1 A 31-year-old male patient with sudden left pleuritic chest pain. A. Enhanced chest CT scan shows that the encapsulated ovoid lesion with internal fat attenuation (arrow), surrounding strands and pericardial thickening (arrowheads) in the left cardiophrenic space. A small pleural effusion is noted in left hemithorax (asterisk). B. USG image through the intercostal space shows an ovoid mass (arrows) with internal heterogeneous echogenicity and surrounding low echoic halo (arrowheads) in the left side of the epipericardial area. C. There is no color flow within the mass on the Doppler USG. D. Follow-up USG obtained two months later demonstrates an interval decrease in lesion size (arrows) with a variable change of the internal echogenicity, as well as resolution of perilesional low echoic halo. E. Follow-up enhanced chest CT scan obtained two months later shows an interval decrease in lesion size (arrow) and resolution of the surrounding strands and pleural effusion in left hemithorax. CT = computed tomography, USG = ultrasonography

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