Key result
Epipericardial fat necrosis resolves spontaneously, showing imaging regression in ~100% of cases.
Why the study?
Epipericardial fat necrosis is a rare, benign condition with variable presentation that lacks a comprehensive synthesis of published cases.
Systematic Review (n=61)
Epipericardial fat necrosis is a rare, benign, and self-limiting condition that typically presents with acute chest pain and can be reliably diagnosed and monitored via computed tomography.
Supports conservative management to avoid unnecessary procedures; extends case-report literature with systematic confirmation of uniform resolution.
Epipericardial fat necrosis (EFN) is a rare, benign condition characterised by localised inflammation and necrosis of fat surrounding the heart. We performed a systematic review of EFN cases published up to June 2024, identifying 61 patients from 46 articles. The mean age was 46.4 years, with a male predominance (60.7%). Nearly all presented with chest pain (98.4%), and pleural symptoms were common (65.6%). EFN was usually left-sided (80.3%), appearing as an encapsulated mass (60.7%) with dense stranding (57.4%). Computed tomography (CT) density was variable, while pleural effusion occurred in 37.7%. Reported management included analgesics or nonsteroidal anti-inflammatory drugs, corticosteroids, and surgical intervention. Among the 36 patients with available follow-up imaging, regression was reported in all cases. Despite its variable presentation, EFN is a self-limiting condition, and CT remains the most reliable imaging modality for diagnosis.
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Ostruszka et al. (2026) conducted a systematic review in Epipericardial fat necrosis (n=61). Epipericardial fat necrosis was evaluated on Clinical presentation, imaging characteristics, and disease regression. Epipericardial fat necrosis is a benign, self-limiting condition that typically presents as left-sided pleuritic chest pain and shows imaging regression in 100% of cases with follow-up.
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