CTICasesPericardial Effusion with Epicardial Fat Sign
Imaging findings
Frontal and lateral chest radiographs demonstrate cardiomegaly with an enlarged cardiac silhouette. The lateral view demonstrates a classic oreo cookie or fat pad sign, showing a central band of fluid sandwiched between the anterior mediastinal fat and the posterior epicardial fat. A corresponding epicardial fat sign is also subtly visible on the frontal projection.
Key takeaways
The epicardial fat pad sign on lateral chest radiography is highly specific for pericardial effusion. It occurs when a layer of pericardial fluid separates the epicardial fat layer from the mediastinal fat layer, creating a distinct sandwich appearance that can confirm an effusion even on plain films.
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