CTICasesAtypical Mediastinal Fat Necrosis
Imaging findings
A patient with right-sided pleuritic chest pain has a very subtle medial opacity on the radiograph with slight loss of the right heart border, persisting on oblique rib views near the site of pain. CT shows a focus of fat necrosis in an atypical location, more anterior along the anterior pleural surface rather than along the pericardium, with a little adjacent atelectasis and no clear pleural effusion.
Key takeaways
Mediastinal fat necrosis can occur in an atypical anterior location along the anterior pleural surface rather than the usual pericardial location, and can be visible on the radiograph (here abutting the right heart border) because of adjacent atelectasis. An ipsilateral pleural effusion is often but not always present, and recognizing the fatty focus with surrounding stranding identifies this benign, self-limited cause of pleuritic pain.
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