• Karina de Souza Giassi, Andre Nathan Costa, Guilherme Hipolito Bachion, Ronaldo Adib Kairalla, and FilhoJosé Rodrigues PargaJRP1 Radiology Division, Hospital Sírio-Libanês, rua Dona Adma Jafet, 91, Bela Vista, São Paulo-SP, 01308-050 Brazil.2 Radiology Institute, Medical School of the University of São Paulo, São Paulo, Brazil..
• 1 Radiology Division, Hospital Sírio-Libanês, rua Dona Adma Jafet, 91, Bela Vista, São Paulo-SP, 01308-050 Brazil.
• AJR Am J Roentgenol. 2016 Oct 1; 207 (4): 773-777.

ObjectiveThe objectives of the present study were to estimate the frequency of epipericardial fat necrosis among patients undergoing chest CT for chest pain and to compare the clinical and laboratory data between patients with epipericardial fat necrosis and control subjects.Materials And MethodsA retrospective review of 7463 chest CT studies performed in the emergency department from July 2011 to December 2014 was conducted to collect data regarding patient demographic characteristics and CT findings. Twenty patients who had epipericardial fat necrosis diagnosed were defined as the main patient group. An age- and sex-matched control group was selected from patients with chest pain who underwent chest CT during the same period. Linear regression models were used to assess data, and statistical significance was expressed as p values and 95% CIs.ResultsWe found that the frequency of epipericardial fat necrosis was 2.15% among patients who underwent chest CT for chest pain. Epipericardial fat necrosis was statistically significantly associated with a lack of medication use (p = 0.01; 95% CI, -3.33 to -0.40) and the absence of other symptoms (p = 0.005; 95% CI, -5.83 to -1.27). Epipericardial fat necrosis was most often observed as an ovoid lesion with mixed fat attenuation with little stranding in the left paracardiac region accompanied by pleural effusion.ConclusionEpipericardial fat necrosis is a significant clinical condition. For patients seen in the emergency department with isolated acute chest pain but no additional clinical history, no medication history, and normal laboratory results, chest CT is recommended to support a diagnosis of epipericardial fat necrosis.

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