alexa Epicardial Fat Mimicking Pericardial Effusion: A Patient with Gastrointestinal Bleeding | OMICS International
ISSN:2167-7964
OMICS Journal of Radiology
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Epicardial Fat Mimicking Pericardial Effusion: A Patient with Gastrointestinal Bleeding

Ozcan Basaran*
Division of Cardiology, Mugla Sitki Kocman University Education and Research Hospital, Mugla, Turkey
Corresponding Author : Ozcan Basaran
Division of Cardiology, Mugla Sitki Kocman
University Education and Research Hospital
Orhaniye Mahallesi Ismet Catak Caddesi, Mugla, Turkey
Tel: +905065359013
Fax: +9025221307 62
E-mail: [email protected]
Received January 23, 2013; Accepted January 26, 2014; Published January 30, 2014
Citation: Basaran O (2014) Epicardial Fat Mimicking Pericardial Effusion: A Patient with Gastrointestinal Bleeding. OMICS J Radiol 3:159. doi:10.4172/2167-7964.1000159
Copyright: © 2014 Basaran O. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricteduse, distribution, and reproduction in any medium, provided the original author and source are credited.

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Keywords
Gastrointestinal bleeding; Epicardial fat; Pericardial effusion
A 49-year-old morbid obese woman admitted our hospital with upper gastrointestinal bleeding. She had been diagnosed with pericardial effusion at two different visits, and had been taking ibuprofen 800 mg twice daily for a month. She had haemetemesis with coffee ground vomiting. Her detailed questioning revealed that she had stomach pain and heartburn occasionally. On her physical examination she was pale and diaphoretic. A complete blood count revealed a white blood cell count of 8.2×106/mL with 54.1% neutrophils, and a hemoglobin level of 8.2 g/dL and hematocrit of 25.8%. Proton pump inhibitor therapy was initiated and ibuprofen was stopped. Her upper gastrointestinal system endoscopy revealed erythematous gastritis. A transthoracic echocardiography (TTE) was performed and pericardial echo-free zone was thought to be epicardial fat rather than pericardial effusion (Figure 1A-1C). Chest contrast-enhanced computed tomography (CT) was performed for further evaluation because of poor image quality on TTE. Epicardial fat was clearly differentiated from pericardial effusion by CT findings (Figure 1D).
Epicardial fat may have a similar echolucent appearance to that of a pericardial effusion. While TTE is usually sufficient for detecting pericardial abnormalities, CT imaging also can be helpful in some cases. Taking account the difficulty of the clinical scenario (obese patient with insufficient image quality on TTE) like in our patient, one should bear in mind CT imaging for differential diagnosis. It is also important to question patients for gastrointestinal symptoms before initiating a nonsteroidal anti-inflammatory drug. This case presentation highlights the need for caution in diagnosing pericardial effusion by echocardiography.

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