0:00

All right. So moving right along we're almost actually done

0:03

with our cases. Let me bring in case 13 and

0:06

so this is a patient who came in with chest pain to

0:09

the ER and this is what you see.

0:14

And let me scroll down.

0:17

And there's a large diaphragmatic. Hernia here. So just

0:20

try to ignore that for a second.

0:24

Sort of looks like it has some Mass Effect on the left ventral, doesn't it?

0:30

And there's a lot of coronary diseases as well.

0:33

So that's a given.

0:35

But where is the primary abnormality besides those

0:38

two things? Where do you think the primary abnormality is?

0:41

And what's what's open up the polling?

0:47

Okay, so, where is it? Is it coronary

0:50

arteries cardiac chamber septimicardium pericardium or

0:53

valves?

1:01

Okay, so let's close the polling here.

1:04

And let's see what people thought so some people thought my cardium

1:07

and some people thought pericardium.

1:10

All right. Well, you know if you said myocardium, that's true.

1:13

I mean, it looks a little bit heterogeneous. That's true. However,

1:16

the more significant abnormality is

1:19

right in here and you can see that this is related. Looks

1:23

like it's related to the pericardium. The funny

1:26

thing is that there really isn't much percordial fluid

1:29

here. This abnormality is really just some stranding

1:32

of the fat a little bit of fluid here. It looks

1:35

like it's contiguous with the pericardium. It doesn't

1:38

quite look like a pericardial effusion and I can

1:41

show you that this is what the patient looks like a few

1:44

days later often. We don't have the luxury of we scanning

1:47

nor should we rescan patients with this particular condition?

1:50

But this is what it looks like in another

1:53

time point. It looks like a glob of fat

1:56

here. That's really right against the

1:59

pericardium and what this is is this is epicardial fat

2:02

pad torsion or

2:05

epic party paracordial fat necrosis. It's

2:08

it's cold.

2:10

And you can you can think of this as the analog of

2:13

epflic appendigitis epiploc

2:16

appendagitis in the abdomen where

2:19

they're fatty appendages on the pericardium along

2:22

the pericardium along the pericardial fat

2:25

and epicurial fat that that can twist and when

2:28

they twist they can cause congestion and

2:31

necrosis of the fat and this can cause chest

2:34

pain that really is very similar to that of

2:37

either per carditis or an acute.

2:40

Am I sometimes so sometimes these patients come in with acute chest

2:43

pain and it's a mystery and the CT

2:46

can be the first place to pick it up. So the treatment is just

2:49

NSAIDs and the

2:52

tincture of time and it's just important to

2:55

realize what this is to not mistake it for something like a fatty

2:58

Mass like a liposarcoma or

3:01

anything like that. It's not quite this either

3:04

it is what it is, which

3:07

is a little fat pad that has

3:10

tourists and and is congested and can

3:13

develop, you know symptoms because of that torsion

3:16

of the fat so so just a case

3:19

to be aware of you may see that in the acute setting