title: Epipericardial Fat Necrosis: Who Should Be a Candidate?
abstract: OBJECTIVE
  The objectives of the present study were to estimate the frequency of epipericardial fat necrosis among patients undergoing chest CT for chest pain and to compare the clinical and laboratory data between patients with epipericardial fat necrosis and control subjects.
  
  
  METHODS
  A retrospective review of 7463 chest CT studies performed in the emergency department from July 2011 to December 2014 was conducted to collect data regarding patient demographic characteristics and CT findings. Twenty patients who had epipericardial fat necrosis diagnosed were defined as the main patient group. An age- and sex-matched control group was selected from patients with chest pain who underwent chest CT during the same period. Linear regression models were used to assess data, and statistical significance was expressed as p values and 95% CIs.
  
  
  RESULTS
  We found that the frequency of epipericardial fat necrosis was 2.15% among patients who underwent chest CT for chest pain. Epipericardial fat necrosis was statistically significantly associated with a lack of medication use (p = 0.01; 95% CI, -3.33 to -0.40) and the absence of other symptoms (p = 0.005; 95% CI, -5.83 to -1.27). Epipericardial fat necrosis was most often observed as an ovoid lesion with mixed fat attenuation with little stranding in the left paracardiac region accompanied by pleural effusion.
  
  
  CONCLUSIONS
  Epipericardial fat necrosis is a significant clinical condition. For patients seen in the emergency department with isolated acute chest pain but no additional clinical history, no medication history, and normal laboratory results, chest CT is recommended to support a diagnosis of epipericardial fat necrosis.
authors.affiliation: 1 Radiology Division, Hospital Sírio-Libanês, rua Dona Adma Jafet, 91, Bela Vista, São Paulo-SP, 01308-050 Brazil.|2 Radiology Institute, Medical School of the University of São Paulo, São Paulo, Brazil.
authors.forename: Karina de Souza
authors.initials: KS
authors.lastname: Giassi
authors.affiliation: 3 Thoracic Diseases Unit, Hospital Sírio-Libanês, São Paulo, Brazil.|4 Pulmonary Division, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Andre Nathan
authors.initials: AN
authors.lastname: Costa
authors.affiliation: 1 Radiology Division, Hospital Sírio-Libanês, rua Dona Adma Jafet, 91, Bela Vista, São Paulo-SP, 01308-050 Brazil.
authors.forename: Guilherme Hipolito
authors.initials: GH
authors.lastname: Bachion
authors.affiliation: 3 Thoracic Diseases Unit, Hospital Sírio-Libanês, São Paulo, Brazil.|4 Pulmonary Division, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Ronaldo Adib
authors.initials: RA
authors.lastname: Kairalla
authors.affiliation: 1 Radiology Division, Hospital Sírio-Libanês, rua Dona Adma Jafet, 91, Bela Vista, São Paulo-SP, 01308-050 Brazil.|2 Radiology Institute, Medical School of the University of São Paulo, São Paulo, Brazil.
authors.forename: José Rodrigues Parga
authors.initials: JRP
authors.lastname: Filho
keywords: acute chest pain; chest pain; epipericardial fat necrosis; fat necrosis; pericardial necrosis