Otaka Yumi, Harada Yukinori, Kawamura Ren, Shimizu Taro
Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, Tochigi 321-0293, Japan.
Eur J Case Rep Intern Med. 2023 Mar 8;10(3):003823. doi: 10.12890/2023_003823. eCollection 2023.
Epipericardial fat necrosis (EFN) is a relatively rare benign disease that causes acute chest pain.
A woman in her 20s presented with acute left shoulder and epigastric pain. One day before presentation, she had visited a cardiologist and an acute coronary syndrome had been ruled out. The pain worsened with deep inspiration. Chest computed tomography (CT) showed a soft-tissue attenuation lesion containing a fatty centre located in the epipericardial fat at the left cardiophrenic angle. Hence, EFN was diagnosed and the pain was resolved with loxoprofen. The lesion had disappeared on a follow-up chest CT scan.
EFN is a rare benign disease that causes acute chest pain. Approximately 70-90% of EFN cases are misdiagnosed by clinicians as other diseases.
In patients with acute chest pain, the correct diagnosis of EFN avoids unnecessary invasive investigations and reassures patients.
Patients with epipericardial fat necrosis typically present with acute pleural chest pain without any associated symptoms.Characteristic CT findings of the encapsulated fatty pericardial lesion with a surrounding inflammatory reaction are key for the diagnosis of epipericardial fat necrosis.The correct diagnosis of epipericardial fat necrosis in patients with acute chest pain reassures them and avoids unnecessary invasive investigation.
心包外脂肪坏死（EFN）是一种相对罕见的引起急性胸痛的良性疾病。
一名20多岁的女性出现急性左肩和上腹部疼痛。在就诊前一天，她曾咨询过心脏病专家，已排除急性冠状动脉综合征。疼痛在深吸气时加重。胸部计算机断层扫描（CT）显示在心左膈角的心包外脂肪中有一个含有脂肪中心的软组织衰减病变。因此，诊断为EFN，疼痛通过洛索洛芬得到缓解。在后续的胸部CT扫描中，病变消失。
EFN是一种引起急性胸痛的罕见良性疾病。大约70-90%的EFN病例被临床医生误诊为其他疾病。
对于急性胸痛患者，正确诊断EFN可避免不必要的侵入性检查并使患者安心。
心包外脂肪坏死患者通常表现为急性胸膜胸痛且无任何相关症状。具有周围炎症反应的包裹性脂肪心包病变的特征性CT表现是诊断心包外脂肪坏死的关键。对急性胸痛患者正确诊断心包外脂肪坏死可使他们安心并避免不必要的侵入性检查。
