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Mediastinal Fat Necrosis
Allen Heeger, DO
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Abbreviations

                • Mediastinal fat necrosis (MFN)
              • Synonyms

                • Epipericardial fat necrosis
                • Pericardial fat necrosis
                  • Misnomer; there is no pericardial fat
                • "Mediastinal fat necrosis"
                  • Preferred over "epipericardial fat necrosis"; lesions do occur away from pericardium
              • Definitions

                • Rare self-limiting cause of pleuritic chest pain
                  • Necrosis of mediastinal fat
                • Subepicardial fat: Immediately adjacent to myocardium
                  • Deep to serous visceral pericardium or epicardium
                • Epiperi-cardial fat: Mediastinal fat superficial to pericardium

              IMAGING

              • General Features

                • Radiographic Findings

                  • CT Findings

                    • MR Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            • Reporting Tips

                                              Selected References

                                              1. Zafar MR et al: Epipericardial fat necrosis: a concise review of literature. Cureus. 13(2):e13106, 2021
                                              2. Cafezeiro CRF et al: Epipericardial fat necrosis as cause of chest pain in patient after heart transplantation. Am J Transplant. 20(5):1451-3, 2020
                                              3. Gayer G: Mediastinal (epipericardial) fat necrosis: an overlooked and little known cause of acute chest pain mimicking acute coronary syndrome. Semin Ultrasound CT MR. 38(6):629-33, 2017
                                              4. Gayer G: Thoracolithiasis-computed tomography findings of intrapleural loose bodies. Semin Ultrasound CT MR. 38(6):634-40, 2017
                                              5. Giassi KS et al: Epipericardial fat necrosis: who should be a candidate? AJR Am J Roentgenol. 207(4):773-7, 2016
                                              6. Giassi Kde S et al: Epipericardial fat necrosis: an underdiagnosed condition. Br J Radiol. 87(1038):20140118, 2014
                                              7. Bhatt MY et al: Imaging manifestations of mediastinal fat necrosis. Case Rep Radiol. 2013:323579, 2013
                                              8. Ataya D et al: Epipericardial fat pad necrosis: computed tomography findings and literature review. J Thorac Imaging. 26(4):W140-2, 2011
                                              9. Fred HL: Pericardial fat necrosis: a review and update. Tex Heart Inst J. 37(1):82-4, 2010
                                              10. Pineda V et al: Epipericardial fat necrosis: radiologic diagnosis and follow-up. AJR Am J Roentgenol. 185(5):1234-6, 2005
                                              Related Anatomy
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                                              Related Differential Diagnoses
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                                              References
                                              Tables

                                              Tables

                                              KEY FACTS

                                              • Terminology

                                                • Imaging

                                                  • Top Differential Diagnoses

                                                    • Pathology

                                                      • Clinical Issues

                                                        • Diagnostic Checklist

                                                          TERMINOLOGY

                                                          • Abbreviations

                                                            • Mediastinal fat necrosis (MFN)
                                                          • Synonyms

                                                            • Epipericardial fat necrosis
                                                            • Pericardial fat necrosis
                                                              • Misnomer; there is no pericardial fat
                                                            • "Mediastinal fat necrosis"
                                                              • Preferred over "epipericardial fat necrosis"; lesions do occur away from pericardium
                                                          • Definitions

                                                            • Rare self-limiting cause of pleuritic chest pain
                                                              • Necrosis of mediastinal fat
                                                            • Subepicardial fat: Immediately adjacent to myocardium
                                                              • Deep to serous visceral pericardium or epicardium
                                                            • Epiperi-cardial fat: Mediastinal fat superficial to pericardium

                                                          IMAGING

                                                          • General Features

                                                            • Radiographic Findings

                                                              • CT Findings

                                                                • MR Findings

                                                                  • Imaging Recommendations

                                                                    DIFFERENTIAL DIAGNOSIS

                                                                      PATHOLOGY

                                                                      • General Features

                                                                        • Gross Pathologic & Surgical Features

                                                                          • Microscopic Features

                                                                            CLINICAL ISSUES

                                                                            • Presentation

                                                                              • Demographics

                                                                                • Natural History & Prognosis

                                                                                  • Treatment

                                                                                    DIAGNOSTIC CHECKLIST

                                                                                    • Consider

                                                                                      • Image Interpretation Pearls

                                                                                        • Reporting Tips

                                                                                          Selected References

                                                                                          1. Zafar MR et al: Epipericardial fat necrosis: a concise review of literature. Cureus. 13(2):e13106, 2021
                                                                                          2. Cafezeiro CRF et al: Epipericardial fat necrosis as cause of chest pain in patient after heart transplantation. Am J Transplant. 20(5):1451-3, 2020
                                                                                          3. Gayer G: Mediastinal (epipericardial) fat necrosis: an overlooked and little known cause of acute chest pain mimicking acute coronary syndrome. Semin Ultrasound CT MR. 38(6):629-33, 2017
                                                                                          4. Gayer G: Thoracolithiasis-computed tomography findings of intrapleural loose bodies. Semin Ultrasound CT MR. 38(6):634-40, 2017
                                                                                          5. Giassi KS et al: Epipericardial fat necrosis: who should be a candidate? AJR Am J Roentgenol. 207(4):773-7, 2016
                                                                                          6. Giassi Kde S et al: Epipericardial fat necrosis: an underdiagnosed condition. Br J Radiol. 87(1038):20140118, 2014
                                                                                          7. Bhatt MY et al: Imaging manifestations of mediastinal fat necrosis. Case Rep Radiol. 2013:323579, 2013
                                                                                          8. Ataya D et al: Epipericardial fat pad necrosis: computed tomography findings and literature review. J Thorac Imaging. 26(4):W140-2, 2011
                                                                                          9. Fred HL: Pericardial fat necrosis: a review and update. Tex Heart Inst J. 37(1):82-4, 2010
                                                                                          10. Pineda V et al: Epipericardial fat necrosis: radiologic diagnosis and follow-up. AJR Am J Roentgenol. 185(5):1234-6, 2005