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另一次胸痛被排除：一个典型的故事，胸部X光（CXR）上的非典型发现导致了罕见的诊断。

Another Chest Pain Ruled Out: A Typical Story With an Atypical Finding on a Chest X-ray (CXR) Leading to an Uncommon Diagnosis.

作者信息

Spector Daniel, Parsons Kevin, Stobart-Gallagher Megan

机构信息

Emergency Medicine, Jefferson Einstein Montgomery Hospital, East Norriton, USA.

Radiology, Jefferson Einstein Philadelphia Hospital, Philadelphia, USA.

出版信息

Cureus. 2025 Mar 16;17(3):e80668. doi: 10.7759/cureus.80668. eCollection 2025 Mar.

DOI:10.7759/cureus.80668
PMID:40236355
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11998620/
Abstract

Epicardial fat necrosis is an uncommon cause of chest pain that mimics pericarditis, pulmonary embolism, and/or coronary syndrome. This is a case of a 55-year-old female patient presenting with left-sided pleuritic chest pain. She had a normal exam and vital signs. Diagnostics showed a non-ischemic electrocardiogram with a negative troponin, an elevated D-dimer, and a chest radiograph showed an opacity along the left cardiac border. Computed tomography-pulmonary angiography (CT-PA) was performed and showed a 4.2 x 1.8 x 3.0 cm lesion, surrounded by a hyperdense ring of high attenuation with fat stranding, which diagnosed epicardial fat necrosis.

摘要

心外膜脂肪坏死是一种罕见的胸痛原因，可酷似心包炎、肺栓塞和/或冠状动脉综合征。这是一例55岁女性患者，表现为左侧胸膜炎性胸痛。她的体格检查和生命体征正常。诊断检查显示心电图无缺血表现、肌钙蛋白阴性、D-二聚体升高，胸部X线片显示左心缘有一不透光区。进行了计算机断层扫描肺动脉造影（CT-PA），显示一个4.2×1.8×3.0厘米的病变，周围有一个高密度的高衰减环并伴有脂肪条索影，诊断为心外膜脂肪坏死。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7fb/11998620/90140d04653c/cureus-0017-00000080668-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7fb/11998620/52f52d52113c/cureus-0017-00000080668-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7fb/11998620/a090b36c72a9/cureus-0017-00000080668-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7fb/11998620/4564103b2b89/cureus-0017-00000080668-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7fb/11998620/90140d04653c/cureus-0017-00000080668-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7fb/11998620/52f52d52113c/cureus-0017-00000080668-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7fb/11998620/a090b36c72a9/cureus-0017-00000080668-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7fb/11998620/4564103b2b89/cureus-0017-00000080668-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7fb/11998620/90140d04653c/cureus-0017-00000080668-i04.jpg

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本文引用的文献

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Epipericardial fat necrosis as a differential diagnosis of acute chest pain: a case report and algorithm proposal for diagnostic approach.心外膜脂肪坏死作为急性胸痛的鉴别诊断：病例报告及诊断方法的算法建议。
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Epipericardial Fat Necrosis: A Concise Review of Literature.心包外脂肪坏死：文献综述
Cureus. 2021 Feb 3;13(2):e13106. doi: 10.7759/cureus.13106.
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Epipericardial Fat Necrosis: A Case Report and a Review of the Literature.
心包外脂肪坏死：一例报告及文献综述
Clin Med Insights Case Rep. 2020 Oct 16;13:1179547620940769. doi: 10.1177/1179547620940769. eCollection 2020.
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Epipericardial Fat Pad Necrosis-A Rare Cause of Chest Pain in an Adolescent.心外膜脂肪垫坏死——青少年胸痛的一个罕见病因。
Pediatr Emerg Care. 2021 Jun 1;37(6):e345-e347. doi: 10.1097/PEC.0000000000001716.
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Pericardial fat necrosis presenting as acute pleuritic chest pain.表现为急性胸膜炎性胸痛的心包脂肪坏死
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