All Title Author
Keywords Abstract


Imaging Manifestations of Mediastinal Fat Necrosis

DOI: 10.1155/2013/323579

Full-Text   Cite this paper   Add to My Lib

Abstract:

Mediastinal fat necrosis (MFN) or epipericardial fat necrosis, as it is commonly referred to in the literature, is a rare self-limiting cause of chest pain of unclear etiology. MFN affects previously healthy individuals who present with acute pleuritic chest pain. Characteristic computed tomography (CT) findings include a fat attenuation lesion with intrinsic and surrounding increased attenuation stranding. There is often associated thickening of the adjacent pericardium and/or pleural effusions. We present two cases of MFN manifesting as ovoid fat attenuation lesions demarcated by a soft tissue attenuation rim with intrinsic and surrounding soft tissue attenuation stranding and review the clinical and pathologic features of these lesions. Knowledge of the clinical presentation of patients with MFN and familiarity with the characteristic imaging findings of these lesions should allow radiologists to prospectively establish the correct diagnosis and suggest conservative management and follow-up. 1. Introduction Mediastinal fat necrosis (MFN) is a rare self-limiting cause of chest pain, with the first reported cases dating back to 1957 [1]. In the current literature, “epipericardial” or “epicardial” fat necrosis is the term used to identify this condition [2–4]. However, as the juxtapericardial mediastinal fat is characteristically affected, we propose that the term MFN is more appropriate given the anatomical location of the disease process. MFN classically affects previously healthy individuals who present with acute pleuritic chest pain that raises concern for an acute cardiopulmonary process including pulmonary thromboembolic and coronary artery diseases [1–12]. We present two cases of MFN and discuss their clinical, pathologic, and imaging findings. In both cases, the affected patients presented with severe chest pain and no associated physical examination findings or specific laboratory abnormalities. The presentation of acute pleuritic chest pain in association with CT findings of an ovoid juxtapericardial fat attenuation lesion with intrinsic and surrounding increased attenuation stranding, thickening of the adjacent pericardium, and resolution on follow-up imaging can be collectively used to establish the diagnosis [2]. Making the correct diagnosis prospectively mitigates unnecessary testing in favor of conservative management. 2. Case Reports Case 1. A 51-year-old man presented with dyspnea and left pleuritic chest pain that radiated to his back. His physical exam and laboratory tests were normal. PA and lateral chest radiographs showed a small

References

[1]  R. C. Jackson, O. T. Clagett, and J. R. McDonald, “Pericardial fat necrosis: report of three cases,” Journal of Thoracic Surgery, vol. 33, pp. 723–729, 1957.
[2]  V. Pineda, J. Cáceres, J. Andreu, J. Vilar, and M. L. Domingo, “Epipericardial fat necrosis: radiologic diagnosis and follow-up,” American Journal of Roentgenology, vol. 185, no. 5, pp. 1234–1236, 2005.
[3]  D. Ataya, A. A. Chowdhry, and T.-L. H. Mohammed, “Epipericardial fat pad necrosis: computed tomography findings and literature review,” Journal of Thoracic Imaging, vol. 26, no. 4, pp. W140–W142, 2011.
[4]  A. Baig, B. Campbell, M. Russell, J. Singh, and S. Borra, “Epicardial fat necrosis: an uncommon etiology of chest pain,” Cardiology Journal, vol. 19, no. 4, pp. 424–428, 2012.
[5]  H. H. Lee, D. S. Ryu, S. S. Jung, S. M. Jung, S. J. Choi, and D. H. Shin, “MRI findings of pericardial fat necrosis: case report,” Korean Journal of Radiology, vol. 12, no. 3, pp. 390–394, 2011.
[6]  D. A. F. Van Den Heuvel, H. W. Van Es, G. A. Cirkel, and W. J. W. Bos, “Acute chest pain caused by pericardial fat necrosis,” Thorax, vol. 65, no. 2, article 188, 2010.
[7]  D. Hernandez, J. Galimany, J. C. Pernas, and J. Llauger, “Case 170: pericardial fat necrosis,” Radiology, vol. 259, no. 3, pp. 919–922, 2011.
[8]  B. Y. Lee and K. S. Song, “Calcified chronic pericardial fat necrosis in localized lipomatosis of pericardium,” American Journal of Roentgenology, vol. 188, no. 1, pp. W21–W24, 2007.
[9]  H. L. Fred, “Pericardial fat necrosis: a review and update,” Texas Heart Institute Journal, vol. 37, no. 1, pp. 82–84, 2010.
[10]  C. D. Chipman, R. L. Aikens, and E. P. Nonamaker, “Pericardial fat necrosis,” Canadian Medical Association Journal, vol. 86, pp. 237–239, 1962.
[11]  V. Pineda, J. Andreu, J. Cáceres, X. Merino, D. Varona, and R. Domínguez-Oronoz, “Lesions of the cardiophrenic space: findings at cross-sectional imaging,” Radiographics, vol. 27, no. 1, pp. 19–32, 2007.
[12]  M. B. Perrin, “Pericardial fat necrosis,” Canadian Journal of Surgery, vol. 4, pp. 76–78, 1960.
[13]  M. E. Gale and W. L. Greif, “Intrafissural fat: CT correlation with chest radiography,” Radiology, vol. 160, no. 2, pp. 333–336, 1986.
[14]  S. C. Gaerte, C. A. Meyer, H. T. Winer-Muram, R. D. Tarver, and D. J. Conces Jr., “Fat-containing lesions of the chest,” Radiographics, vol. 22, pp. s61–s78, 2002.
[15]  A. Kamaya, M. P. Federle, and T. S. Desser, “Imaging manifestations of abdominal Fat necrosis and its mimics,” Radiographics, vol. 31, no. 7, pp. 2021–2034, 2011.
[16]  G. G. Ghahremani, E. M. White, F. L. Hoff, R. M. Gore, J. W. Miller, and M. L. Christ, “Appendices epiploicae of the colon: radiologic and pathologic features,” Radiographics, vol. 12, no. 1, pp. 59–77, 1992.
[17]  A. K. Singh, D. A. Gervais, P. F. Hahn, J. Rhea, and P. R. Mueller, “CT appearance of acute appendagitis,” American Journal of Roentgenology, vol. 183, no. 5, pp. 1303–1307, 2004.

Full-Text

comments powered by Disqus