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

A-35-Year-Old-Woman-With-Acute-Pleuritic Ches

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The case involves a 35-year-old woman presenting with acute left-sided pleuritic chest pain persistent for two days. Notably, she had no significant medical history, was non-smoker, and had recently given birth 4 months prior. Her vital stats were stable, and she exhibited no signs of dyspnea, cough, or fever, and her ECG was normal. Laboratory tests showed mildly elevated white blood cells, elevated C-reactive protein, and D-dimer levels. While a chest X-ray was mostly normal, a lateral view revealed a small left pleural effusion and retrosternal mass.<br /><br />Further investigation with chest CT angiography ruled out pulmonary embolism but identified a fatty lesion in the left cardiophrenic angle surrounded by inflammatory tissue along with a pleural effusion. The resulting diagnosis was epipericardial fat necrosis (EFN), an underrecognized cause of pleuritic chest pain. EFN is characterized by fatty lesions and often misdiagnosed, especially if initial examination and imaging tests appear normal.<br /><br />EFN is benign and managed effectively with nonsteroidal anti-inflammatory drugs (NSAIDs), with CT follow-up showing resolution over weeks. Surgery is unnecessary, as exemplified by this patient, who improved with aspirin alone. Historically, EFN diagnosis has often been overlooked due to inadequate imaging or misinterpretation, though the rise of CT and ultrasound helps differentiate it from serious conditions.<br /><br />Sonographic imaging shows promise in diagnosing EFN, highlighting its safety advantage over radiographs. Correct diagnosis and treatment of EFN avoid unnecessary surgeries. This condition is notably benign, with symptomatic relief occurring rapidly after treatment, and radiological changes resolving shortly thereafter.

Keywords

epipericardial fat necrosis

pleuritic chest pain

pleural effusion

fatty lesion

nonsteroidal anti-inflammatory drugs

CT angiography

retrosternal mass

diagnosis

sonographic imaging

benign condition