[Acute chest pain caused by pericardial fat necrosis: a diagnosis to consider in some patients].

A 55-year-old woman presented at the emergency department with acute pleuritic chest pain. The pain was located on the left side of the sternum. Her relevant medical history revealed gastro-oesophageal reflux disease. Physical examination, laboratory investigations and a plain chest radiograph were normal. The patient was thought to be suffering from gastro-oesophageal reflux disease and was treated with antacids. After 3 days she visited the outpatient clinic with the same complaints but now there was also shortness of breath. A CT-angiogram was performed to exclude a pulmonary embolism and to look for an alternative diagnosis. This showed pericardial fat necrosis (figure 1). Pericardial fat necrosis is an uncommon cause of acute pleuritic chest pain. It is a self-limiting benign disorder which sometimes presents as a pericardial mass. Its aetiology is unknown but pathology shows encapsulated fat necrosis as is found in epiploic appendagitis or fat necrosis in the omentum or breast. A plain chest radiograph can be normal or may show an increased opacity in the paracardial space. CT scan reveals a fatty lesion in the pericardial fat with surrounding inflammatory changes, pericardial and/or pleural thickening and occasionally pleural fluid. Because of its self-limiting nature treatment is conservative. Our patient was treated symptomatically with a non-steroidal anti-inflammatory drug and was free of symptoms at 4 weeks of follow-up. D A F van den Heuvel, H W van Es, G A Cirkel, W J W Bos Department of Radiology, St Antonius Hospital, Nieuwegein, The Netherlands; Department of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands