CHEST Guidelines-A-35-Year-Old-Woman-With-Acute-Pleuritic Ches (1)

A-35-Year-Old-Woman-With-Acute-Pleuritic Ches (1)

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In this case study, a 35-year-old woman experienced acute, nonradiating, left-sided pleuritic chest pain following childbirth four months earlier. Despite normal vital signs and physical exams, laboratory tests revealed an elevated white blood cell count and C-reactive protein, while D-dimer levels were slightly higher than normal. Initial chest radiographs showed no significant issues, but a CT angiography revealed a fatty lesion in the left cardiophrenic angle, surrounded by inflammatory tissue and a small pleural effusion. This was diagnosed as Epipericardial Fat Necrosis (EFN), a condition leading to chest pain due to necrosis of fat in the pericardial or epipericardial region.<br /><br />EFN is not well-documented, making its frequency hard to assess. In a retrospective study, it was found in about 2% of patients who underwent CT scans for chest pain. Causes are uncertain but may include torsion of a vascular pedicle or increased intrathoracic pressure. In this patient's case, the postpartum period might have contributed to the condition, although this remains speculative.<br /><br />EFN is primarily diagnosed through CT scans, showing a fatty lesion encapsulated with inflammatory tissue. It can occasionally be misdiagnosed as other conditions due to normal examination findings. Treatment typically involves nonsteroidal anti-inflammatory drugs (NSAIDs) with follow-up imaging to confirm resolution of the condition, avoiding unnecessary surgical procedures. This patient was treated with aspirin due to an initial suspicion of pericarditis, showing significant improvement in follow-up imaging. EFN is generally benign, and appropriate diagnosis can prevent unnecessary interventions and promote a positive patient outcome.

Keywords

Epipericardial Fat Necrosis

pleuritic chest pain

CT angiography

postpartum

fatty lesion

inflammatory tissue

nonsteroidal anti-inflammatory drugs

retrospective study

D-dimer

pericarditis