The silent occupant: Fatty infiltration of the heart in autopsy

Adipositas cordis, defined by excessive fat accumulation within and around the myocardium, is a frequently overlooked finding at autopsy. Often dismissed as a benign consequence of obesity or aging, this entity may have important pathological and forensic implications. From a pathologist’s perspective, adipositas cordis presents distinct gross and microscopic features, including marked epicardial fat, myocardial fatty infiltration, and associated myocyte atrophy or fibrosis. These changes can alter cardiac structure and electrical stability, potentially contributing to arrhythmias and sudden death. Accurate recognition is essential to distinguish adipositas cordis from pathological mimickers such as arrhythmogenic cardiomyopathy and ischemic heart disease. In medico-legal autopsies, its role is usually contributory rather than causative, demanding careful interpretation within the clinical and circumstantial context. Thoughtful documentation and clinicopathological correlation help prevent misattribution of cause of death. Increased awareness of adipositas cordis enriches cardiovascular autopsy practice and underscores the nuanced relationship between cardiac adiposity and fatal outcomes.