C43-14 Epicardial Fat Pad Necrosis: A Rare Cause Of Chest Pain With Characteristic Imaging Findings

Abstract INTRODUCTION Epicardial (or epipericardial) fat pad necrosis (EFPN) is a rare, benign, and self-limited inflammatory process involving mediastinal fat adjacent to the pericardium. It typically presents with chest pain and can mimic acute coronary syndrome or pulmonary embolism. Recognition of its characteristic history and imaging findings can prevent unnecessary diagnostic procedures and interventions. CASE DESCRIPTION 50 year old female without significant medical history presented for evaluation after multiple emergency department (ED) visits for chest pain and dyspnea. Two months prior, she experienced acute left-sided chest pain associated with pleurisy. She was seen in the ED and was discharged with Cyclobenzaprine, with subsequent improvement of her symptoms. Two weeks later, the patient developed exertional dyspnea with associated chest pain. The patient returned to the ED and had a computed tomography (CT) scan which suggested “atelectasis” and pulmonary embolism was ruled out. The patient was then referred to pulmonary clinic for further evaluation. Symptoms were still present on evaluation in pulmonary clinic. Patient without any fevers, chills, weight loss, cough, injury or trauma. Physical examination was unremarkable with no reproducible tenderness to palpation or any abnormal auscultatory findings. Prior ED labs reviewed with normal troponin, electrocardiogram, and chest radiograph. The CT scan of chest was reviewed which demonstrated a focal area of rounded fat attenuation in the left anterior mediastinum adjacent to the pericardium with mild fat stranding and loculated pleural effusion (image 1). The patient was managed conservatively with observation and supportive care. A repeat CT chest three months after the initial image showed interval improvement with decreased size of the fatty lesion and associated effusion. The patient’s dyspnea and chest discomfort had completely resolved at time of follow up imaging. Discussion Historically EFPN presented as a juxtacardiac mass on chest radiography, and many were removed due to concerns for malignancy. This case highlights the diagnostic value of CT in identifying EFPN which is characterized by an ovoid epicardial mediastinal fatty lesion with surrounding soft tissue stranding. A pleural effusion may or may not be present. Clinical history and CT imaging findings may help differentiate EFPN from lipoma, thymolipoma, liposarcoma, or pericardial cyst. EFPN is self-limiting, and accurate recognition can prevent unnecessary interventions and spare patients of alleviate patient anxiety. This abstract is funded by: None