Fat in and Around the Heart

Normal and Normal Variants

Epicardial and Pericardial Fat

THE PERICARDIUM , EPICARDIAL FAT AND PERICARDIAL FAT                                     CT scan through the 4 chambers shows a normal  pericardium (white line) surrounded by an inner lining of epicardial fat (yellow in contact with the red myocardium ) and an outer layer of pericardial fat)  .  Note that the coronary arteries (white dots run in the epicardial fat.                                                                        Ashley Davidoff MD heart anatomy P 086

Large Amount of Epicardial and Pericardial Fat associated with

    • increased cardiovascular risk, especially for coronary artery disease.
PERICARDIAL FAT
An axial T1 weighted MRI shows a large amount of fat (yellow overlay) around the heart. The epicardial fat is the inner layer and is intimately related to the heart and the pericardial fat is the outer layer. The normal pericardium is seen as a black line between the two layers of fat. Although the pericardium looks like a single layer, it actually consists of two structures – the epicardial serous component and the pericaricardial fibrous component. In pericardial effusion the two layers are separated.
The amount of fat is more than expected and this amount is often associated with Syndrome X.
Courtesy of Ashley Davidoff M.D. 32141.8 code normal heart epicardial fat pericardium anatomy cardiac imaging radiology MRI

 

Epicardial Fat with Mild Pressure Effect on the RV

EPICARDIAL FAT
CT scan through the RV and LV shows epicardial fatty accumulation in the subendocardium of the right ventricle. The normal pericardium, (white arrowhead) and normal epicardial fat (yellow arrowhead) are shown in the lower images.
Ashley Davidoff MD
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Degenerative and Age Related Changes in the RV
AGE RELATED FAT INFILTRATION
Axial, non contrast CT scan of a 100 year old female showing physiological accumulations of fat in the right ventricle (RV) and likely in the papillary muscles of the left ventricle (LV)
Ashley Davidoff MD
In the RV Wall
CT scan through the RV shows fatty infiltration in the right ventricle. The normal pericardium, (white arrow) normal epicardial fat (orange) arrowhead) and fat infiltrating the RV (yellow arrow) are shown in (b)
Ashley Davidoff MD
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Atrial Septal Lipoma

ATRIAL LIPOMA
Axial CT scan through the heart is from a 71year old female who is on steroid therapy. A large amount of fat is noted in the epicardium (yellow arrowhead) and also in the interatrial septum resulting in an atrial lipoma.

In CAD and prior Myocardial Infarction
FAT IN THE VENTRICULAR SEPTUM – PRIOR SEPTAL INFARCTION
Clinical summary of a 65 year old female with longstanding history of SLE, Lupus Sjogren’s and Raynaud’s presented with 2 weeks of dyspnea and elevated troponins suggestive of a STEMI. Cardiac cath showed 2 vessel disease and she was referred for CABG. At surgery there were adhesions and the surgeon was unable to identify the coronaries as a result of the fibrosis. She was closed without surgery. She subsequently had a diagnostic MRI and endomyocardial biopsy which showed chloroquine related cardiomyopathy
Ashley Davidoff MD
FAT AND CALCIUM IN THE HEART
56 year old male with history of coronary artery disease. Axial CT through the heart shows apical curvilinear fat (yellow arrowheads, ( a and b) associated with apical myocardial dystrophic calcification (green arrowheads c and d) both indicating prior apical MI. In addition there mitral annular calcification (red arrowhead, b) and multifocal fatty deposits in the RV (white arrowheads, a and b) usually depicting age related degenerative changes,
Ashley Davidoff MD

 

Unusual cases
Pericardial Lipoma

 

LIPOMA OF THE PERICARDIUM  
CXR shows widening of the left main bronchus and a vague lucency at the apex of the heart,  CT shows lipoma  posterior to the LA
Lipoma at the SVC RA junction
LIPOMA OF THE SVC -RA JUNCTION
This image of a coronally acquired T1 weighted MRI image of the heart shows a high intensity mass surrounding the SVC and the entrance right atrium (RA) with narrowing of the SVC. There were no symptoms of SVC syndrome in this patient with known COPD. Note that the mass has the intensity of subcutaneous fat. An atrial lipoma is the most likely diagnosis.
Courtesy Jorge Medina
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KEY WORDS
Cardiac, heart, vein, SVC , RA, mass, fat, lipoma, tumor, neoplasm, benign, imaging, radiology, MRI
LIPOMA OF THE SVC AND RA
This series of axial T1 weighted MRI images of the heart show a high intensity mass surrounding the SVC (blue arrowhead) and the entrance to the right atrium (RA). There were no symptoms of SVC syndrome in this patient with known COPD. Note that the mass has the intensity of subcutaneous fat. An atrial lipoma is the most likely diagnosis.
Courtesy Jorge Medina

LIPOMA OF THE SVC AND RA
This series of axial and coronal T1 weighted MRI images of the heart show a high intensity mass surrounding the SVC and the entrance to the right atrium. There were no symptoms of SVC syndrome in this patient with known COPD. Note that the mass has the intensity of the subcutaneous fat. An atrial lipoma is the most likely diagnosis.
Courtesy Jorge Medina
38449c
KEY WORDS
Cardiac, heart, vein, SVC , RA, mass, fat, lipoma, tumor, neoplasm, benign, imaging, radiology, MRI

FAT NECROSIS-Target shaped

EPICARDIAL FAT NECROSIS
79-year male with asymptomatic finding on axial CT of a focal sclerotic ring surround the epicardial fat on the right side of the heart (yellow arrowhead). This most likely reflects chronic epicardial fat necrosis
Ashley Davidoff MD
EPICARDIAL FAT NECROSIS
79-year male with asymptomatic finding on coronally reformatted CT of a focal sclerotic ring surround the epicardial fat on the right side of the heart (yellow arrowhead). This most likely reflects chronic epicardial fat necrosis
Ashley Davidoff MD
EPICARDIAL FAT NECROSIS
79-year male with asymptomatic finding on sagittally reformatted CT of a focal sclerotic ring surround the epicardial fat on the right side of the heart (yellow arrowhead). This most likely reflects chronic epicardial fat necrosis
Ashley Davidoff MD

Lipoma of the LV

PROBABLE LIPOMA OF THE LV
37 year old male with no history of CAD with a fat containing nodule at the LV apex most likely representing a lipoma of the myocardium
Ashley Davidoff MD
NODULAR FATTY DEPOSITS IN LV ( yellow arrow), IN RV(orange arrow) and AROUND RV (green arrow)
AMYLOIDOSIS TRACHEA BRONCHI BRONCHIOLES
56-year-old female with stable tracheobronchial amyloidosis.
The CXR shows in the AP projection shows a small tubular density which on CT reflect as a small bronchus which is thickened and contains calcification. The lateral exam shows bronchial wall thickening
The CT shows multicentric thickening of the trachea and bronchi.
The bronchi to the left lower lobe and a middle lobe bronchus are thickened and contain calcium
There is nodular fat accumulation along the lateral wall and apex of the LV and within the RV. There is also linear fat accumulation in the mid septal region and prominent pericardial fat around the anterior wall of the RV
Ashley Davidoff MD

Kimura et al  Myocardial Fat at Cardiac Imaging: How Can We Differentiate Pathologic from Physiologic Fatty Infiltration?  RadioGraphicsVol. 30, No. 6