Acute Chest Pain Related to Pericardial Fat Necrosis

An otherwise healthy 56-year-old woman (BMI, 31 kg/m2) presented to our emergency department with acute nonradiating left-sided chest pain. She had no associated dyspnea, fever, or other clinical findings. An electrocardiogram and serum troponin level were unremarkable. Nonenhanced computed tomography (CT) of the chest (Figure 1) showed a left anterior low-attenuation (−80 HU) pericardial mass with high attenuation strands measuring 47 mm in diameter, surrounded by an irregular capsule (arrow), and with an associated small pleural effusion (arrowhead). Coronal reformation CT confirmed no connection with infradiaphragmatic tissues (Figure 2). Contrast-enhanced CT (Figure 3) ruled out pulmonary embolism and aortic dissection but confirmed the typical appearance of pericardial fat necrosis. With nonsteroidal anti-inflammatory treatment the pain disappeared. On follow-up CT after 3 months (Figure 4), the mass was still present but significantly reduced in size (28 mm) (arrow).