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Abstract：
Epipericardial fat necrosis (EFN) is a benign and self-limited condition of unknown cause with a good prognosis, usually affecting otherwise healthy patients. Clinically, it presents with severe acute left pleuritic chest pain, often leading the patient to the Emergency Room (ER).
A 23-year-old male, smoker (5 pack-years), was evaluated in the ER due to left pleuritic chest pain, worsening with deep breathing and Valsalva maneuver. It was not associated with trauma and did not present other symptoms. The physical examination was unremarkable. The arterial blood gases while breathing room air and the laboratory tests, including D-dimers and high-sensitivity cardiac Troponin T, were normal. The chest radiograph, electrocardiogram, and transthoracic echocardiogram showed no abnormalities. A computed tomography (CT) pulmonary angiogram showed no signs of pulmonary embolism but depicted at the left cardiophrenic angle a focal 3 cm ovoid-shaped fat lesion with stranding and thin soft tissue margins, consistent with necrosis of the epicardial fat, which was confirmed by magnetic resonance (MRI) of the chest. The patient was medicated with ibuprofen and pantoprazole, with clinical improvement in four weeks. At a two-month follow-up, he was asymptomatic and presented radiologic resolution of the inflammatory changes of the epicardial fat of the left cardiophrenic angle on chest CT. Laboratory tests revealed positive antinuclear antibodies, positive anti-RNP antibody, and positive lupus anticoagulant. The patient complained of biphasic Raynaud\'s phenomenon initiated five years ago, and a diagnosis of undifferentiated connective tissue disease (UCTD) was made.
This case report highlights the diagnosis of EFN as a rare and frequently unknown clinical condition, which should be considered in the differential diagnosis of acute chest pain. It can mimic emergent conditions such as pulmonary embolism, acute coronary syndrome, or acute pericarditis. The diagnosis is confirmed by CT of the thorax or MRI. The treatment is supportive and usually includes non-steroidal anti-inflammatory drugs. The association of EFN with UCTD has not been previously described in the medical literature.
A 23-year-old male, smoker (5 pack-years), was evaluated in the ER due to left pleuritic chest pain, worsening with deep breathing and Valsalva maneuver. It was not associated with trauma and did not present other symptoms. The physical examination was unremarkable. The arterial blood gases while breathing room air and the laboratory tests, including D-dimers and high-sensitivity cardiac Troponin T, were normal. The chest radiograph, electrocardiogram, and transthoracic echocardiogram showed no abnormalities. A computed tomography (CT) pulmonary angiogram showed no signs of pulmonary embolism but depicted at the left cardiophrenic angle a focal 3 cm ovoid-shaped fat lesion with stranding and thin soft tissue margins, consistent with necrosis of the epicardial fat, which was confirmed by magnetic resonance (MRI) of the chest. The patient was medicated with ibuprofen and pantoprazole, with clinical improvement in four weeks. At a two-month follow-up, he was asymptomatic and presented radiologic resolution of the inflammatory changes of the epicardial fat of the left cardiophrenic angle on chest CT. Laboratory tests revealed positive antinuclear antibodies, positive anti-RNP antibody, and positive lupus anticoagulant. The patient complained of biphasic Raynaud\'s phenomenon initiated five years ago, and a diagnosis of undifferentiated connective tissue disease (UCTD) was made.
This case report highlights the diagnosis of EFN as a rare and frequently unknown clinical condition, which should be considered in the differential diagnosis of acute chest pain. It can mimic emergent conditions such as pulmonary embolism, acute coronary syndrome, or acute pericarditis. The diagnosis is confirmed by CT of the thorax or MRI. The treatment is supportive and usually includes non-steroidal anti-inflammatory drugs. The association of EFN with UCTD has not been previously described in the medical literature.
摘要：
背景：心脑血管脂肪坏死（EFN）是一种病因不明的良性自限性疾病，预后良好，通常影响健康的患者。临床上,它表现为严重的急性左胸膜炎性胸痛，通常将患者带到急诊室（ER）。
方法：一名23岁男性，吸烟者（5包年），由于左胸膜炎性胸痛，在急诊室进行了评估，随着深呼吸和Valsalva动作的恶化。它与创伤无关，也没有其他症状。体检并不显著。呼吸室内空气时的动脉血气和实验室检查，包括D-二聚体和高敏心肌肌钙蛋白T,是正常的。胸部X光片,心电图,经胸超声心动图未见异常。计算机断层扫描（CT）肺血管造影显示没有肺栓塞的迹象，但在左心膈角描绘了3厘米的局灶性卵形脂肪病变，具有绞合和薄的软组织边缘，与心外膜脂肪坏死一致，通过胸部磁共振（MRI）证实。病人服用了布洛芬和泮托拉唑,在四周内临床改善。在两个月的随访中，他无症状，在胸部CT上表现为左心膈角心外膜脂肪的炎性改变的放射学分辨率。实验室检测显示抗核抗体阳性,抗RNP抗体阳性，狼疮抗凝物阳性.患者抱怨五年前开始的双相雷诺现象，并诊断为未分化结缔组织病（UCTD）。
结论：本病例报告强调了EFN的诊断是一种罕见且经常未知的临床疾病，在急性胸痛的鉴别诊断中应考虑这一点。它可以模拟紧急情况，如肺栓塞，急性冠脉综合征,或急性心包炎。诊断通过胸部CT或MRI证实。治疗是支持性的，通常包括非甾体抗炎药。EFN与UCTD的关联以前没有在医学文献中描述过。
方法：一名23岁男性，吸烟者（5包年），由于左胸膜炎性胸痛，在急诊室进行了评估，随着深呼吸和Valsalva动作的恶化。它与创伤无关，也没有其他症状。体检并不显著。呼吸室内空气时的动脉血气和实验室检查，包括D-二聚体和高敏心肌肌钙蛋白T,是正常的。胸部X光片,心电图,经胸超声心动图未见异常。计算机断层扫描（CT）肺血管造影显示没有肺栓塞的迹象，但在左心膈角描绘了3厘米的局灶性卵形脂肪病变，具有绞合和薄的软组织边缘，与心外膜脂肪坏死一致，通过胸部磁共振（MRI）证实。病人服用了布洛芬和泮托拉唑,在四周内临床改善。在两个月的随访中，他无症状，在胸部CT上表现为左心膈角心外膜脂肪的炎性改变的放射学分辨率。实验室检测显示抗核抗体阳性,抗RNP抗体阳性，狼疮抗凝物阳性.患者抱怨五年前开始的双相雷诺现象，并诊断为未分化结缔组织病（UCTD）。
结论：本病例报告强调了EFN的诊断是一种罕见且经常未知的临床疾病，在急性胸痛的鉴别诊断中应考虑这一点。它可以模拟紧急情况，如肺栓塞，急性冠脉综合征,或急性心包炎。诊断通过胸部CT或MRI证实。治疗是支持性的，通常包括非甾体抗炎药。EFN与UCTD的关联以前没有在医学文献中描述过。
