Extensive Epipericardial Fat Necrosis in a Case of Metastatic Adenocarcinoma of Lung

Epipericardial fat necrosis is an uncommon benign and self-limiting condition that leads patients to the emergency department owing to the onset of acute pleuritic chest pain. Fat necrosis in adipose tissue can occur at various sites: in the breast and subcutaneous fat after trauma, peripancreatic fat in pancreatitis, and epiploicappendagitis.[1,2] Rarely, it may occur within the epipericardial fat. Since the first description by Jackson et al.,[3] only 35 cases have been published in the English literature, and extensive epipericardial fat necrosis (EFN) is currently described as an extremely rare disease.[4] The aetiology of EFN remains unknown, but some theories have been proposed to explain its origin. Acute torsion of a vascular pedicle is described in some cases, although the presence of a vascular pedicle has been described in only two patients who underwent surgery.[4] Furthermore, increased intrathoracic pressure due to heavy lifting or Valsalva's manoeuvre might trigger rapid changes in capillary pressure, leading to haemorrhagic necrosis, especially if pre-existing structural abnormalities of the adipose tissue, such as lipoma, hamartoma or lipomatosis, are present.[5] Both males and females are affected, and neither age predilections nor pre-disposing factors have been described.[4]