Encapsulated pericardial fat necrosis treated by video-assisted thoracic surgery: Report of a case

A 55-year-old moderately obese man who was admitted to a local hospital fol lowing a traffic accident reported having experienced an episode of sharp a nd sudden pleuritic pain in the left anterior lower chest 2 days earlier. A computed tomographic scan on admission demonstrated a nonhomogeneous mass in the anterior left side of the chest, abutting the left cardiac margin, a nd a left-sided pleural effusion. As a mediastinal tumor was suspected, he was referred to our hospital for investigation and treatment, An explorator y thoracotomy was performed by video-assisted thoracic surgery (VATS) about 3 weeks later, which revealed a firm, yellowish mass on the oral side of t he pericardial fat pad, adhering to the anterior chest wall. The mass was e asily removed, The resected specimen consisted of a lobulated fragment of a dipose tissue measuring 5.0 x 3.5 x 2.0 cm, and the final pathologic diagno sis was pericardial fat necrosis. The patient had an uneventful postoperati ve recovery and has remained free of symptoms for 10 months since his opera tion. Pericardial fat necrosis remains a rare clinical entity. Surgical exc ision by VATS achieves symptomatic cure and probably continues to be the tr eatment of choice because of the need to exclude a neoplasm in the differen tial diagnosis.