CTICasesMediastinal/Epicardial Nodular Fat Necrosis (or Necrosed Lipoma)
Imaging findings
Chest radiograph demonstrates an abnormal convexity along the right heart border in the anterior mediastinum. Initial CT reveals a fatty mass with subtle soft tissue streaks. Subsequent CT shows increased internal stranding and soft tissue components, though the overall size remains stable. Surgical pathology confirmed nodular fat necrosis, consistent with epicardial or mediastinal fat necrosis, potentially arising within a pre-existing lipoma.
Key takeaways
Mediastinal fatty lesions can undergo necrosis, presenting with changing internal stranding and soft tissue attenuation over time. While the differential includes lipoma or teratoma, nodular fat necrosis (including epicardial/mediastinal fat necrosis) should be considered, possibly as a complication within a lipoma.
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