Caceres’ Corner: Case No. 40 (Update: Solution)

Dear Friends,

Muppet is so happy with your performance that he has chosen a challenging case. The following radiographs belong to a 52-year-old woman with two episodes of chest pain in six weeks. The initial radiograph is shown, as well as a radiograph taken during the second episode. At that time, a CT was done.

Fig. 1

Fig. 2


1. Pulmonary infarct
2. Lymphadenopathy
3. Loculated pericardial fluid
4. None of the above

Click here for the answer to case #40

Be Sociable, Share!
    Oct 2012
    DISCUSSION 15 Comments

    15 Responses to : Caceres’ Corner: Case No. 40 (Update: Solution)

    1. Albert says:

      In the second Rx there is an abnormal convexity of the apical heart shadow on the left. On the CT there is a pseudonodular incresed attenuation of the epicardial fat next to the heart apex.
      I would suggest an epicardial fat infarct (somebody call it epicardial appendagitis but I think it is equivocal).

    2. Mm says:

      I agree with albert. Also known as epicardial fat necrosis.

    3. Dr J says:

      Pericardial fat necrosis

    4. Ricardo Macareno says:

      The chest film identifies an area of ​​increased opacity in the region paracardiac left. In axial CT identifies injury margins encapsulated fat crisp uniform.

      In this context clinical findings are compatible with pericardial fat necrosis.

    5. Artur says:

      You are too fast guys 🙂

    6. Ricardo Reis says:

      Too fast indeed! Pericardial fat necrosis! 🙂

      PS – Dr Caceres it was great to hear your lectures one week ago in Barcelona!

    7. vaggoul says:

      Pericardial fat pad necrosis

    8. Genchi Bari Italia says:

      Forse l’illustre collega è troppo buono ed euforico per il 5 a 0 del Real al Maiorca, per cui ha proposto un caso x far fare bella figura ai concorrenti: necrosi appendice pericardio.

    9. Angelis Barlampas says:

      there is a lesion of fatty density that abuts the pericardium of cardiac apex. After the iv contrast administration there is only minimal periferal enhancement. If we combine these findings with the clinical history of pain , it could be a rare focal epicardium fat necrosis, although we can not see the fat <> at the first radiograph.
      We have to consider other possible diagnoses too. For example an epicardiac cyst , with transient exudative inflammation , explains the pain ,the nearly fatty and the flecs of soft tissue density, why we can not see it at the first exam, and the contrast patern.
      As regards the loculated pericardial fluid , it could be such a case , but we would have expect to see clues of chrocic pericarditis, which we don’t.
      This is not a common site for lymphnodes. The rare epiphrenic lymphnodes , usually happen at lower positions.
      And of course this is not the classic appearance of a pneumonic infact.

      • Jose Caceres says:

        Since 2005 I have seen seven cases of pericardial necrosis in Barcelona. I believe this entity is more common than believed.
        And some cases present with a normal chest radiograph, They are discovered with CT.
        Congratulations for an excellent discussion

    10. Xose says:

      Thanks a lot for your beatiful and educacional cases, Dr. Caceres!